Provider Demographics
NPI:1174802094
Name:SHERMAN, SUSAN J (MSW, LCSW)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:J
Last Name:SHERMAN
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 FAWN MEADOW DR
Mailing Address - Street 2:
Mailing Address - City:NAUGATUCK
Mailing Address - State:CT
Mailing Address - Zip Code:06770-3577
Mailing Address - Country:US
Mailing Address - Phone:203-577-6419
Mailing Address - Fax:203-577-6423
Practice Address - Street 1:180 CHURCH ST STE 12
Practice Address - Street 2:
Practice Address - City:NAUGATUCK
Practice Address - State:CT
Practice Address - Zip Code:06770-4144
Practice Address - Country:US
Practice Address - Phone:203-525-2113
Practice Address - Fax:203-723-3735
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-09
Last Update Date:2020-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0075731041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT45-2662186OtherEMPLOYER IDENTIFICATION NUMBER (EIN)