Provider Demographics
NPI:1194064568
Name:SHERBONDY, DEANA (MA, LMHC)
Entity type:Individual
Prefix:MRS
First Name:DEANA
Middle Name:
Last Name:SHERBONDY
Suffix:
Gender:F
Credentials:MA, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:809 JEFFERSON AVENUE
Mailing Address - Street 2:
Mailing Address - City:LA PORTE
Mailing Address - State:IN
Mailing Address - Zip Code:46350-3431
Mailing Address - Country:US
Mailing Address - Phone:219-898-5646
Mailing Address - Fax:
Practice Address - Street 1:809 JEFFERSON AVE
Practice Address - Street 2:
Practice Address - City:LA PORTE
Practice Address - State:IN
Practice Address - Zip Code:46350-3431
Practice Address - Country:US
Practice Address - Phone:219-898-5646
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-02-05
Last Update Date:2017-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN39002214A101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN39002214AMedicaid