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General NPI Number Information
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NPI Number | 1144484437
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Entity Type | Individual
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Provider Name | MARK EDEN SHERMAN LCSW
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Gender | Male
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Dates
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Enumeration Date | 07/15/2008
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Last Update Date | 02/11/2022
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Provider Practice Location Address
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Address Line | 4301 NW WILSON ROAD BH UNIT
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City | FT SILL
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State | OK
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Zip | 73503-4472
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Country | US
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Telephone | 580-558-8283
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Fax |
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Provider Business Mailing Address
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Address Line | 6504 NW OAK AVE # B-11
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City | LAWTON
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State | OK
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Zip | 73505-4367
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Country | US
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Telephone | 816-200-9572
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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 | 001963
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License Number State | MO
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