MEDICARE: JENNIFER SHERMAN QBHS 3

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor	OH
2	103K00000X	Behavior Analyst	OH
3	171M00000X	Case Manager/Care Coordinator
4	101Y00000X	Counselor	OH
5	101YM0800X	Mental Health Counselor	OH

General Provider Information

NPI Number	:	1083477848
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER SHERMAN QBHS 3

Provider Business Mailing Address
First Line	:	11201 SHAKER BLVD STE 200
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44104-3869
Country	:	US
Telephone Number	:	216-273-7073
Fax Number	:

Provider Business Practice Location Address
First Line	:	11201 SHAKER BLVD STE 200
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44104-3869
Country	:	US
Telephone Number	:	216-273-7073
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/05/2024
Last Update Date	:	01/11/2026

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