=====================================================
General NPI Number Information
=====================================================
NPI Number | 1750490488
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SHIRLEY Y SHERWOOD LCSW AAC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/29/2006
-----------------------------------------------------
Last Update Date | 12/19/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 902 CRYSTAL FALLS PKWY
-----------------------------------------------------
City | LEANDER
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78641-3646
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 512-421-4023
-----------------------------------------------------
Fax | 512-259-2290
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 902 CRYSTAL FALLS PKWY
-----------------------------------------------------
City | LEANDER
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78641-3646
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 512-421-4023
-----------------------------------------------------
Fax | 512-259-2290
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 104100000X
-----------------------------------------------------
Taxonomy Name | Social Worker
-----------------------------------------------------
License Number | 505976
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 101Y00000X
-----------------------------------------------------
Taxonomy Name | Counselor
-----------------------------------------------------
License Number | 10620800
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------