MEDICARE: LAURA ELISSA SHERWOOD LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	73611	CA

General Provider Information

NPI Number	:	1770467524
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAURA ELISSA SHERWOOD LCSW

Provider Business Mailing Address
First Line	:	8140 VALLEY VIEW DR
Second Line	:
City	:	SEBASTOPOL
State	:	CA
Zip	:	95472-3136
Country	:	US
Telephone Number	:	831-345-4992
Fax Number	:

Provider Business Practice Location Address
First Line	:	5340 SKYLANE BLVD
Second Line	:
City	:	SANTA ROSA
State	:	CA
Zip	:	95403-8246
Country	:	US
Telephone Number	:	707-524-2600
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/04/2025
Last Update Date	:	08/04/2025

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