Provider Demographics
NPI:1871056481
Name:LYM, SHERILL L (RN)
Entity type:Individual
Prefix:
First Name:SHERILL
Middle Name:L
Last Name:LYM
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:324 LANTANA AVE
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07631-1510
Mailing Address - Country:US
Mailing Address - Phone:201-788-9665
Mailing Address - Fax:201-569-2433
Practice Address - Street 1:324 LANTANA AVE
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07631-1510
Practice Address - Country:US
Practice Address - Phone:201-788-9665
Practice Address - Fax:201-569-2433
Is Sole Proprietor?:No
Enumeration Date:2019-04-10
Last Update Date:2019-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0506486Medicaid