Provider Demographics
NPI:1538309802
Name:ANDERSON-VOGT, SHERALD G (LCSW)
Entity type:Individual
Prefix:
First Name:SHERALD
Middle Name:G
Last Name:ANDERSON-VOGT
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2315 SMOKERISE DR
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76016-1237
Mailing Address - Country:US
Mailing Address - Phone:817-247-2623
Mailing Address - Fax:
Practice Address - Street 1:1160 COUNTRY CLUB LN
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76112-2303
Practice Address - Country:US
Practice Address - Phone:817-496-9796
Practice Address - Fax:817-451-4104
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-26
Last Update Date:2010-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX312781041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX199967401Medicaid