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General NPI Number Information
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NPI Number | 1063545580
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Entity Type | Individual
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Provider Name | NANCY SHERTOK M.S.W, L.C.S.W.
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Gender | Female
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Dates
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Enumeration Date | 03/13/2007
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Last Update Date | 04/14/2020
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Provider Practice Location Address
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Address Line | 2620 CLAIRVIEW ST
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City | ALPHARETTA
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State | GA
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Zip | 30009-8325
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Country | US
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Telephone | 678-929-5905
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Fax | 770-609-6918
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Provider Business Mailing Address
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Address Line | 2620 CLAIRVIEW ST
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City | ALPHARETTA
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State | GA
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Zip | 30009-8325
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Country | US
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Telephone | 678-929-5905
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 149021254
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 2138-123
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License Number State | WI
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Taxonomy #3
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | CSW004874
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License Number State | GA
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