Provider Demographics
NPI:1427272145
Name:SHERWOOD, ELLEN M (LCPC)
Entity type:Individual
Prefix:
First Name:ELLEN
Middle Name:M
Last Name:SHERWOOD
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 FIELD WAY
Mailing Address - Street 2:
Mailing Address - City:ELLSWORTH
Mailing Address - State:ME
Mailing Address - Zip Code:04605
Mailing Address - Country:US
Mailing Address - Phone:207-664-7594
Mailing Address - Fax:
Practice Address - Street 1:194 MAIN ST
Practice Address - Street 2:SUITE 4
Practice Address - City:ELLSWORTH
Practice Address - State:ME
Practice Address - Zip Code:04605-1939
Practice Address - Country:US
Practice Address - Phone:207-460-3408
Practice Address - Fax:207-669-6300
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-12
Last Update Date:2014-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECC2178101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME303580099Medicaid