=====================================================
General NPI Number Information
=====================================================
NPI Number | 1508905621
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SHERRI MICHELE FLOURNOY LCSW R
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/05/2007
-----------------------------------------------------
Last Update Date | 04/11/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 87 - 86 188TH STREET 1 LEVEL
-----------------------------------------------------
City | HOLLIS
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11423
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 917-863-6910
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1150 OSSIPEE ROAD
-----------------------------------------------------
City | WEST HEMPSTEAD
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11552
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 516-536-1835
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | R0532581
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------