Provider Demographics
NPI:1174728521
Name:HANSEL, SHERRY BUCHANAN (LCSW)
Entity type:Individual
Prefix:
First Name:SHERRY
Middle Name:BUCHANAN
Last Name:HANSEL
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:552 SUMMIT AVE
Mailing Address - Street 2:
Mailing Address - City:MAPLEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07040-1341
Mailing Address - Country:US
Mailing Address - Phone:973-761-6886
Mailing Address - Fax:
Practice Address - Street 1:420 BOULEVARD
Practice Address - Street 2:SUITE 101
Practice Address - City:MOUNTAIN LAKES
Practice Address - State:NJ
Practice Address - Zip Code:07046-1742
Practice Address - Country:US
Practice Address - Phone:973-627-4087
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC051886001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ070157A51Medicare ID - Type UnspecifiedCLINICAL SOCIAL WORKER