MEDICARE: MS. ROBERTA L SHERWOOD MA MFT

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	106H00000X	Marriage & Family Therapist	MFC35651	CA

General Provider Information

NPI Number	:	1922187137
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. ROBERTA L SHERWOOD MA MFT

Provider Business Mailing Address
First Line	:	3400 VALLEY DRIVE
Second Line	:	39
City	:	MANHATTAN BEACH
State	:	CA
Zip	:	90266
Country	:	US
Telephone Number	:	310-546-3037
Fax Number	:	310-546-8794

Provider Business Practice Location Address
First Line	:	3760 MOTOR AVE
Second Line	:	SUITE 215
City	:	LOS ANGELES
State	:	CA
Zip	:	90034
Country	:	US
Telephone Number	:	310-558-9855
Fax Number	:	310-546-8794

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

Provider Enumeration Date	:	11/06/2006
Last Update Date	:	07/08/2007

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