Healthcare Provider Details

I. General information

NPI: 1982830790
Provider Name (Legal Business Name): KAREN R. SHERIDAN PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2009
Last Update Date: 11/03/2025
Certification Date: 11/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

422 COLONIAL DR
BATON ROUGE LA
70806-6505
US

IV. Provider business mailing address

PO BOX 66558
BATON ROUGE LA
70896-6558
US

V. Phone/Fax

Practice location:
  • Phone: 225-922-0644
  • Fax:
Mailing address:
  • Phone: 225-922-2700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number1096
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number010
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: