Provider Demographics
NPI:1316930142
Name:ESTES, SHEREE L (PSY D)
Entity type:Individual
Prefix:DR
First Name:SHEREE
Middle Name:L
Last Name:ESTES
Suffix:
Gender:F
Credentials:PSY D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:189 MAY ST
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01602-4339
Mailing Address - Country:US
Mailing Address - Phone:508-791-6351
Mailing Address - Fax:208-361-8739
Practice Address - Street 1:189 MAY ST
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01602-4339
Practice Address - Country:US
Practice Address - Phone:508-791-6351
Practice Address - Fax:508-624-4845
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-26
Last Update Date:2011-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA7927103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
W06094OtherBLUE CROSS
1029500OtherBEACON
MA1892436Medicaid
385602OtherMAGELLAN
ESW51007Medicare ID - Type Unspecified