Provider Demographics
NPI:1598865446
Name:PETRUSO, SHERI LYNN (MSW, LCSW)
Entity type:Individual
Prefix:
First Name:SHERI
Middle Name:LYNN
Last Name:PETRUSO
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:SHERI
Other - Middle Name:LYNN
Other - Last Name:FERNANDEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW LCSW
Mailing Address - Street 1:1600 HERITAGE LANDING
Mailing Address - Street 2:SUITE 116
Mailing Address - City:ST PETERS
Mailing Address - State:MO
Mailing Address - Zip Code:63303
Mailing Address - Country:US
Mailing Address - Phone:636-345-1400
Mailing Address - Fax:636-441-3262
Practice Address - Street 1:1600 HERITAGE LANDING
Practice Address - Street 2:SUITE 116
Practice Address - City:ST PETERS
Practice Address - State:MO
Practice Address - Zip Code:63303
Practice Address - Country:US
Practice Address - Phone:636-345-1400
Practice Address - Fax:636-441-3262
Is Sole Proprietor?:No
Enumeration Date:2006-09-22
Last Update Date:2010-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO0050521041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO498946417Medicaid