Provider Demographics
NPI:1770615569
Name:REEDY, SHERYL L (LICSW, MSW)
Entity type:Individual
Prefix:MRS
First Name:SHERYL
Middle Name:L
Last Name:REEDY
Suffix:
Gender:F
Credentials:LICSW, MSW
Other - Prefix:
Other - First Name:SHERYL
Other - Middle Name:L
Other - Last Name:ROTHSTEIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW
Mailing Address - Street 1:191 SOCIAL ST
Mailing Address - Street 2:SUITE 590
Mailing Address - City:WOONSOCKET
Mailing Address - State:RI
Mailing Address - Zip Code:02895-3240
Mailing Address - Country:US
Mailing Address - Phone:401-769-4373
Mailing Address - Fax:401-769-0397
Practice Address - Street 1:191 SOCIAL ST
Practice Address - Street 2:SUITE 590
Practice Address - City:WOONSOCKET
Practice Address - State:RI
Practice Address - Zip Code:02895-3240
Practice Address - Country:US
Practice Address - Phone:401-769-4373
Practice Address - Fax:401-769-0397
Is Sole Proprietor?:No
Enumeration Date:2007-03-09
Last Update Date:2009-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIISW014691041C0700X
RI317921041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
RISR40829Medicaid
RISR40829Medicaid