Healthcare Provider Details

I. General information

NPI: 1740361773
Provider Name (Legal Business Name): SHERENELLE F SUMNER LCSW-R
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/18/2006
Last Update Date: 10/05/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

790 ROUTE 211 E
MIDDLETOWN NY
10941-1448
US

IV. Provider business mailing address

8 TOMS LN
NEWBURGH NY
12550-1727
US

V. Phone/Fax

Practice location:
  • Phone: 845-764-7977
  • Fax: 845-566-3657
Mailing address:
  • Phone: 845-566-3097
  • Fax: 845-566-3657

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberR059041-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: