Provider Demographics
NPI:1588793632
Name:HIDALGO, SHERYL M (LCSW)
Entity type:Individual
Prefix:
First Name:SHERYL
Middle Name:M
Last Name:HIDALGO
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:SHERYL
Other - Middle Name:M
Other - Last Name:CHAYKIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4740 N STATE ROAD 7
Mailing Address - Street 2:
Mailing Address - City:LAUDERDALE LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:33319-5839
Mailing Address - Country:US
Mailing Address - Phone:954-486-4005
Mailing Address - Fax:954-497-3857
Practice Address - Street 1:330 SW 27TH AVE
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33312-2051
Practice Address - Country:US
Practice Address - Phone:954-791-4300
Practice Address - Fax:954-497-3857
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-05
Last Update Date:2018-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW45871041C0700X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL763864700Medicaid