=====================================================
General NPI Number Information
=====================================================
NPI Number | 1316549439
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MARY ELEANOR SHERWOOD MS, CDMS, CCM
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/13/2020
-----------------------------------------------------
Last Update Date | 11/13/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 116 FRONT ST UNIT 737
-----------------------------------------------------
City | LEWES
-----------------------------------------------------
State | DE
-----------------------------------------------------
Zip | 19958-8028
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 410-444-1989
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 25 HOORNKILL AVE
-----------------------------------------------------
City | LEWES
-----------------------------------------------------
State | DE
-----------------------------------------------------
Zip | 19958-1201
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 302-644-1827
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number | 17-98351-67
-----------------------------------------------------
License Number State | DE
-----------------------------------------------------