Provider Demographics
NPI:1154186633
Name:ABBASPOUR, SHERISA (LMSW)
Entity type:Individual
Prefix:
First Name:SHERISA
Middle Name:
Last Name:ABBASPOUR
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:ALICIA
Other - Middle Name:
Other - Last Name:ABBASPOUR
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:600 PARK PL APT 18
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11238-4776
Mailing Address - Country:US
Mailing Address - Phone:317-496-2922
Mailing Address - Fax:
Practice Address - Street 1:600 PARK PL APT 18
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11238-4776
Practice Address - Country:US
Practice Address - Phone:317-496-2922
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-14
Last Update Date:2024-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY116735-01104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker