Healthcare Provider Details

I. General information

NPI: 1902991409
Provider Name (Legal Business Name): SHERRY L. HOMAN LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 HOSPITAL RD.
WALTON NY
13856
US

IV. Provider business mailing address

186 OLD PLANK RD.
DEPOSIT NY
13754
US

V. Phone/Fax

Practice location:
  • Phone: 607-865-6522
  • Fax: 607-865-7424
Mailing address:
  • Phone: 607-467-2926
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number071129-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: