Provider Demographics
NPI:1841273018
Name:SHERIDAN, JANICE L (LCSW)
Entity type:Individual
Prefix:
First Name:JANICE
Middle Name:L
Last Name:SHERIDAN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2900 FRANK SCOTT PKWY
Mailing Address - Street 2:STE 956B
Mailing Address - City:BELLEVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62223
Mailing Address - Country:US
Mailing Address - Phone:618-235-9092
Mailing Address - Fax:618-235-9093
Practice Address - Street 1:2900 FRANK SCOTT PKWY
Practice Address - Street 2:STE 956B
Practice Address - City:BELLEVILLE
Practice Address - State:IL
Practice Address - Zip Code:62223
Practice Address - Country:US
Practice Address - Phone:618-235-9092
Practice Address - Fax:618-235-9093
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
738400Medicare ID - Type Unspecified