Provider Demographics
NPI:1245522465
Name:SHERMAN, STACEY PESCHEL (LMSW, BCBA)
Entity type:Individual
Prefix:MS
First Name:STACEY
Middle Name:PESCHEL
Last Name:SHERMAN
Suffix:
Gender:F
Credentials:LMSW, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:419 THE PARKWAY
Mailing Address - Street 2:PMB #141
Mailing Address - City:GREER
Mailing Address - State:SC
Mailing Address - Zip Code:29650
Mailing Address - Country:US
Mailing Address - Phone:803-582-8012
Mailing Address - Fax:
Practice Address - Street 1:419 THE PARKWAY, PMB #141
Practice Address - Street 2:ABA AUTISM SERVICES OF SC, LLP
Practice Address - City:GREER
Practice Address - State:SC
Practice Address - Zip Code:29650
Practice Address - Country:US
Practice Address - Phone:803-582-8012
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-05-05
Last Update Date:2016-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1-11-8013103K00000X
SC9747104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No104100000XBehavioral Health & Social Service ProvidersSocial Worker