Provider Demographics
NPI:1154535441
Name:TRAKHTENBROIT, SHERIE SUE (LCSW)
Entity type:Individual
Prefix:MRS
First Name:SHERIE
Middle Name:SUE
Last Name:TRAKHTENBROIT
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 1:11731 ELMSCOURT
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78230-2758
Mailing Address - Country:US
Mailing Address - Phone:210-492-3951
Mailing Address - Fax:210-493-2933
Practice Address - Street 1:255 E SONTERRA BLVD
Practice Address - Street 2:SUITE 150
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78258-4075
Practice Address - Country:US
Practice Address - Phone:210-492-3951
Practice Address - Fax:210-493-2933
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX356951041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical