Provider Demographics
NPI:1477701993
Name:SHERIDAN, ROBERT S
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:S
Last Name:SHERIDAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:85 E NEWTON ST
Mailing Address - Street 2:BEST; GROUND FLOOR, BAYCOVE
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02118-2340
Mailing Address - Country:US
Mailing Address - Phone:617-414-8336
Mailing Address - Fax:617-414-8333
Practice Address - Street 1:85 E NEWTON ST
Practice Address - Street 2:BEST; GROUND FLOOR, BAYCOVE
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02118-2340
Practice Address - Country:US
Practice Address - Phone:617-414-8336
Practice Address - Fax:617-414-8333
Is Sole Proprietor?:No
Enumeration Date:2008-09-09
Last Update Date:2008-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health