Provider Demographics
NPI:1033248349
Name:CHERRY, DRUSILLA DEMAREST (MSSW)
Entity type:Individual
Prefix:MS
First Name:DRUSILLA
Middle Name:DEMAREST
Last Name:CHERRY
Suffix:
Gender:F
Credentials:MSSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3333 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:STRATFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06614-4861
Mailing Address - Country:US
Mailing Address - Phone:203-380-1153
Mailing Address - Fax:203-380-2563
Practice Address - Street 1:3333 MAIN ST
Practice Address - Street 2:
Practice Address - City:STRATFORD
Practice Address - State:CT
Practice Address - Zip Code:06614-4861
Practice Address - Country:US
Practice Address - Phone:203-380-1153
Practice Address - Fax:203-380-2563
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0001139104100000X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered104100000XBehavioral Health & Social Service ProvidersSocial Worker
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical