Provider Demographics
NPI:1144041906
Name:SMITH, SHERIDAN A (LSW)
Entity type:Individual
Prefix:
First Name:SHERIDAN
Middle Name:A
Last Name:SMITH
Suffix:
Gender:X
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1880 JFK BLVD STE 1110
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19103-7447
Mailing Address - Country:US
Mailing Address - Phone:215-544-7600
Mailing Address - Fax:
Practice Address - Street 1:1880 JOHN F KENNEDY BLVD STE 1110
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19103-7447
Practice Address - Country:US
Practice Address - Phone:152-544-7600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-23
Last Update Date:2024-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW141013101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional