Provider Demographics
NPI:1962869073
Name:HANNAN, SHERRY (LCSW)
Entity type:Individual
Prefix:
First Name:SHERRY
Middle Name:
Last Name:HANNAN
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 1:200 BUTLER DR
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02906-4863
Mailing Address - Country:US
Mailing Address - Phone:401-437-8981
Mailing Address - Fax:401-437-8344
Practice Address - Street 1:200 BUTLER DR
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02906-4863
Practice Address - Country:US
Practice Address - Phone:401-437-8981
Practice Address - Fax:401-437-8344
Is Sole Proprietor?:No
Enumeration Date:2016-01-20
Last Update Date:2016-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RICSW01829104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker