Healthcare Provider Details

I. General information

NPI: 1972694867
Provider Name (Legal Business Name): SHERRY M ZITTER MSW, LISCW, BCD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/27/2006
Last Update Date: 10/05/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

45 LYMAN ST STE 19
WESTBOROUGH MA
01581-2658
US

IV. Provider business mailing address

21 LEWIS ST
MAYNARD MA
01754-1345
US

V. Phone/Fax

Practice location:
  • Phone: 508-366-8576
  • Fax:
Mailing address:
  • Phone: 978-562-1801
  • Fax: 978-562-1801

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number106060
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: