Provider Demographics
NPI:1346224375
Name:FALSETTI, SHERRY A (PHD)
Entity type:Individual
Prefix:
First Name:SHERRY
Middle Name:A
Last Name:FALSETTI
Suffix:
Gender:F
Credentials:PHD
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Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1601 PARKVIEW AVE
Mailing Address - Street 2:CREDENTIALING S233
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61107-1822
Mailing Address - Country:US
Mailing Address - Phone:815-395-5861
Mailing Address - Fax:815-395-5575
Practice Address - Street 1:1221 E STATE ST
Practice Address - Street 2:UNIVERSITY FAMILY HEALTH CENTER
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61104-2231
Practice Address - Country:US
Practice Address - Phone:815-972-1000
Practice Address - Fax:815-972-1033
Is Sole Proprietor?:No
Enumeration Date:2005-12-02
Last Update Date:2014-05-20
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Provider Licenses
StateLicense IDTaxonomies
IL0710065042084P0800X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL204391Medicare PIN