Provider Demographics
NPI:1881762177
Name:SHERMAN, LAURIE GORDAN (MA)
Entity type:Individual
Prefix:MS
First Name:LAURIE
Middle Name:GORDAN
Last Name:SHERMAN
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:60 MAIDEN LN
Mailing Address - Street 2:
Mailing Address - City:KINGSTON
Mailing Address - State:NY
Mailing Address - Zip Code:12401-4506
Mailing Address - Country:US
Mailing Address - Phone:845-331-2870
Mailing Address - Fax:
Practice Address - Street 1:60 MAIDEN LN
Practice Address - Street 2:
Practice Address - City:KINGSTON
Practice Address - State:NY
Practice Address - Zip Code:12401-4506
Practice Address - Country:US
Practice Address - Phone:845-331-2870
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-02
Last Update Date:2020-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003329-1101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health