Provider Demographics
NPI:1043870918
Name:WALDEN, SHERYL (LICSW)
Entity type:Individual
Prefix:
First Name:SHERYL
Middle Name:
Last Name:WALDEN
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11093 GETTYSBURG DR
Mailing Address - Street 2:
Mailing Address - City:ALTA LOMA
Mailing Address - State:CA
Mailing Address - Zip Code:91737-7827
Mailing Address - Country:US
Mailing Address - Phone:909-224-6682
Mailing Address - Fax:
Practice Address - Street 1:2177 E WARNER RD
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85284-3511
Practice Address - Country:US
Practice Address - Phone:909-224-6682
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-13
Last Update Date:2019-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCLC500817211041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical