Provider Demographics
NPI:1801948849
Name:SHERBAK, JAN F (PSYD)
Entity type:Individual
Prefix:
First Name:JAN
Middle Name:F
Last Name:SHERBAK
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3023 BROAD ST
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37408-3075
Mailing Address - Country:US
Mailing Address - Phone:423-752-5207
Mailing Address - Fax:423-752-5299
Practice Address - Street 1:3023 BROAD ST
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37408-3075
Practice Address - Country:US
Practice Address - Phone:423-752-5207
Practice Address - Fax:423-752-5299
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-18
Last Update Date:2011-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNP02400103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3164854OtherBLUE CROSS BLUE SHIELD
TN455336000OtherMAGELLAN