Provider Demographics
NPI:1447449939
Name:SHERIDAN, MARTA (EDD, LPC)
Entity type:Individual
Prefix:DR
First Name:MARTA
Middle Name:
Last Name:SHERIDAN
Suffix:
Gender:F
Credentials:EDD, LPC
Other - Prefix:MISS
Other - First Name:MARTA
Other - Middle Name:
Other - Last Name:SCALISE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10100 ELIDA RD
Mailing Address - Street 2:
Mailing Address - City:DELPHOS
Mailing Address - State:OH
Mailing Address - Zip Code:45833-9056
Mailing Address - Country:US
Mailing Address - Phone:419-695-8010
Mailing Address - Fax:419-695-0004
Practice Address - Street 1:12500 E ILIFF AVE
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80014-1268
Practice Address - Country:US
Practice Address - Phone:720-506-9645
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-19
Last Update Date:2020-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO6500101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health