Doctor Name: | MARY B. SHERIDAN |
NPI Number: | 1063878338 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | LSCSW |
License Number: | 4309 |
Business Practice Address: | 12760 W 87th Street Pkwy Suite 108 Lenexa, KS - 662154635 |
Business Phone Number: | 9134411200 |
Business Fax Number: | |
Mailing Address: | Po Box 860700, SHAWNEE |
State: | KS |
Postal Code: | 662860700 |
Phone Number: | 9134411200 |
Fax Number: | |
NPI Enumeration Date: | 01/02/2016 |
NPI Last Update Date: | 01/02/2016 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 1041C0700X |
License Number: | 4309 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | KS |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Social Worker |
Taxonomy Specialization: | Clinical |
Taxonomy Definition: | A social worker who holds a master |