Provider Demographics
NPI:1043633134
Name:SMITH, SHERRY SUE (LCSW)
Entity type:Individual
Prefix:
First Name:SHERRY
Middle Name:SUE
Last Name:SMITH
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1987 WILSHIRE CT
Mailing Address - Street 2:
Mailing Address - City:BUFFALO GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60089-8004
Mailing Address - Country:US
Mailing Address - Phone:847-732-4510
Mailing Address - Fax:
Practice Address - Street 1:977 LAKEVIEW PKWY STE 102
Practice Address - Street 2:
Practice Address - City:VERNON HILLS
Practice Address - State:IL
Practice Address - Zip Code:60061-1444
Practice Address - Country:US
Practice Address - Phone:847-732-4510
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-27
Last Update Date:2021-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0036371041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical