Provider Demographics
NPI:1730365263
Name:ISHERWOOD, SORREL MADRONA (LCSW, MPH)
Entity type:Individual
Prefix:MRS
First Name:SORREL
Middle Name:MADRONA
Last Name:ISHERWOOD
Suffix:
Gender:F
Credentials:LCSW, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1547 PALOS VERDES MALL
Mailing Address - Street 2:SUITE 437
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94597-2228
Mailing Address - Country:US
Mailing Address - Phone:925-595-4699
Mailing Address - Fax:
Practice Address - Street 1:1547 PALOS VERDES MALL
Practice Address - Street 2:SUITE 437
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94597-2228
Practice Address - Country:US
Practice Address - Phone:925-595-4699
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-15
Last Update Date:2008-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA216611041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical