Doctor Name: | MARTY SHERMAN |
NPI Number: | 1063834240 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | LADC |
License Number: | 300851 |
Business Practice Address: | 1018 Greeley Ave N Glencoe, MN - 553362128 |
Business Phone Number: | 8886330211 |
Business Fax Number: | |
Mailing Address: | 1018 Greeley Ave N, GLENCOE |
State: | MN |
Postal Code: | 553362128 |
Phone Number: | 8886330211 |
Fax Number: | |
NPI Enumeration Date: | 01/07/2014 |
NPI Last Update Date: | 01/07/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YA0400X |
License Number: | 300851 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MN |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Addiction (Substance Use Disorder) |
Taxonomy Definition: |