Provider Demographics
NPI:1194327502
Name:SHERWIN, GARY (AOD)
Entity type:Individual
Prefix:
First Name:GARY
Middle Name:
Last Name:SHERWIN
Suffix:
Gender:M
Credentials:AOD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2945 TOWNSGATE RD STE 200
Mailing Address - Street 2:
Mailing Address - City:WESTLAKE VILLAGE
Mailing Address - State:CA
Mailing Address - Zip Code:91361-5866
Mailing Address - Country:US
Mailing Address - Phone:805-342-0222
Mailing Address - Fax:805-480-4965
Practice Address - Street 1:2945 TOWNSGATE RD STE 200
Practice Address - Street 2:
Practice Address - City:WESTLAKE VILLAGE
Practice Address - State:CA
Practice Address - Zip Code:91361-5866
Practice Address - Country:US
Practice Address - Phone:805-342-0222
Practice Address - Fax:805-480-4965
Is Sole Proprietor?:No
Enumeration Date:2020-11-10
Last Update Date:2020-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACI21350119101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)