MEDICARE: MR. MARK A. SHERMAN LCSW

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	LCS14106	CA
2	1041C0700X	Clinical Social Worker	LCS14106	CA

General Provider Information

NPI Number	:	1386637932
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. MARK A. SHERMAN LCSW

Provider Business Mailing Address
First Line	:	2181 S EL CAMINO REAL
Second Line	:	SUITE 307
City	:	OCEANSIDE
State	:	CA
Zip	:	92054-6288
Country	:	US
Telephone Number	:	760-721-4500
Fax Number	:	760-512-3113

Provider Business Practice Location Address
First Line	:	2181 S EL CAMINO REAL STE 307
Second Line	:
City	:	OCEANSIDE
State	:	CA
Zip	:	92054-6288
Country	:	US
Telephone Number	:	760-721-4500
Fax Number	:	760-512-3113

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

Provider Enumeration Date	:	08/30/2005
Last Update Date	:	01/11/2023

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