Provider Demographics
NPI:1730358425
Name:BROWN, SHERRY PINE (LCSW)
Entity type:Individual
Prefix:
First Name:SHERRY
Middle Name:PINE
Last Name:BROWN
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 1:10 LOWER NOTCH ROAD
Mailing Address - Street 2:APARTMENT 2
Mailing Address - City:WOODLAND PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07424-2273
Mailing Address - Country:US
Mailing Address - Phone:973-951-0253
Mailing Address - Fax:845-639-7098
Practice Address - Street 1:10 LOWER NOTCH ROAD
Practice Address - Street 2:APARTMENT 2
Practice Address - City:WOODLAND PARK
Practice Address - State:NJ
Practice Address - Zip Code:07424-2273
Practice Address - Country:US
Practice Address - Phone:973-951-0253
Practice Address - Fax:845-639-7098
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-27
Last Update Date:2021-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJSC 06067104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ038393Medicare PIN