Healthcare Provider Details

I. General information

NPI: 1902664592
Provider Name (Legal Business Name): SHERANN KAMILAH NOLLEY ALKINS LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/08/2024
Last Update Date: 03/08/2024
Certification Date: 03/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

47 GOODALE RD # 3
BOSTON MA
02126-1527
US

IV. Provider business mailing address

47 GOODALE RD # 3
BOSTON MA
02126-1527
US

V. Phone/Fax

Practice location:
  • Phone: 413-222-6138
  • Fax:
Mailing address:
  • Phone: 413-222-6138
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number419440
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number342541
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: