Healthcare Provider Details

I. General information

NPI: 1417883356
Provider Name (Legal Business Name): SHERILYN PETERSON DOUDS LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/19/2026
Last Update Date: 06/19/2026
Certification Date: 06/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3605 LONG BEACH BLVD STE 306
LONG BEACH CA
90807-6018
US

IV. Provider business mailing address

3605 LONG BEACH BLVD STE 306
LONG BEACH CA
90807-6018
US

V. Phone/Fax

Practice location:
  • Phone: 562-428-3266
  • Fax:
Mailing address:
  • Phone: 562-428-3266
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number65318
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: