Provider Demographics
NPI:1174345466
Name:SHERMAN, JASON EDMOND (LADC)
Entity type:Individual
Prefix:
First Name:JASON
Middle Name:EDMOND
Last Name:SHERMAN
Suffix:
Gender:M
Credentials:LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:58 GREENE AVE APT B
Mailing Address - Street 2:
Mailing Address - City:CANAAN
Mailing Address - State:CT
Mailing Address - Zip Code:06018-2456
Mailing Address - Country:US
Mailing Address - Phone:845-489-8146
Mailing Address - Fax:
Practice Address - Street 1:300 CHURCH STREET
Practice Address - Street 2:SUITE 205
Practice Address - City:WALLINGFORD
Practice Address - State:CT
Practice Address - Zip Code:06492
Practice Address - Country:US
Practice Address - Phone:845-489-8146
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-28
Last Update Date:2024-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTMSW.009853101YM0800X
CT44.001584101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health