Provider Demographics
NPI:1770579997
Name:SHERMAN, ALISA ANN (LCSW-R)
Entity type:Individual
Prefix:MRS
First Name:ALISA
Middle Name:ANN
Last Name:SHERMAN
Suffix:
Gender:F
Credentials:LCSW-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:199 JERICHO TPKE
Mailing Address - Street 2:SUITE 202
Mailing Address - City:FLORAL PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11001-2100
Mailing Address - Country:US
Mailing Address - Phone:516-488-1101
Mailing Address - Fax:516-488-1151
Practice Address - Street 1:199 JERICHO TPKE
Practice Address - Street 2:SUITE 202
Practice Address - City:FLORAL PARK
Practice Address - State:NY
Practice Address - Zip Code:11001-2100
Practice Address - Country:US
Practice Address - Phone:516-488-1101
Practice Address - Fax:516-488-1151
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-22
Last Update Date:2007-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR0290611041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYR27298Medicare UPIN
NYN6C812Medicare PIN