Provider Demographics
NPI:1588981930
Name:BOURSIQUOT, SHERLY (BSW)
Entity type:Individual
Prefix:
First Name:SHERLY
Middle Name:
Last Name:BOURSIQUOT
Suffix:
Gender:F
Credentials:BSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2510 SCOTT ST
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33020-2357
Mailing Address - Country:US
Mailing Address - Phone:305-305-3857
Mailing Address - Fax:954-923-3205
Practice Address - Street 1:2510 SCOTT ST
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33020-2357
Practice Address - Country:US
Practice Address - Phone:305-305-3857
Practice Address - Fax:954-923-3205
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-26
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker