MEDICARE: SHERRIE THANG WALLER 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	1041C0700X	Clinical Social Worker	091962	NY

General Provider Information

NPI Number	:	1497270466
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHERRIE THANG WALLER LCSW

Provider Business Mailing Address
First Line	:	3421 78TH ST APT 6I
Second Line	:
City	:	JACKSON HEIGHTS
State	:	NY
Zip	:	11372-2514
Country	:	US
Telephone Number	:	347-201-0249
Fax Number	:

Provider Business Practice Location Address
First Line	:	3421 78TH ST APT 6I
Second Line	:
City	:	JACKSON HEIGHTS
State	:	NY
Zip	:	11372-2514
Country	:	US
Telephone Number	:	347-201-0249
Fax Number	:

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

Provider Enumeration Date	:	08/10/2017
Last Update Date	:	10/30/2025

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