MEDICARE: ASHLEY SHERBERT 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	SW19257	FL

General Provider Information

NPI Number	:	1558061622
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ASHLEY SHERBERT LCSW

Provider Business Mailing Address
First Line	:	5332 PLANTATION HOME WAY
Second Line	:
City	:	PORT ORANGE
State	:	FL
Zip	:	32128-7529
Country	:	US
Telephone Number	:	386-569-7293
Fax Number	:

Provider Business Practice Location Address
First Line	:	5332 PLANTATION HOME WAY
Second Line	:
City	:	PORT ORANGE
State	:	FL
Zip	:	32128-7529
Country	:	US
Telephone Number	:	386-569-7293
Fax Number	:

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

Provider Enumeration Date	:	03/07/2023
Last Update Date	:	03/07/2023

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Directions to “ ASHLEY SHERBERT LCSW” Practice Location

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