1942842521 NPI number — CATHERINE FAITH SHERBOURNE ADC-II, LICSW

Table of content: CATHERINE FAITH SHERBOURNE ADC-II, LICSW (NPI 1942842521)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1942842521 NPI number — CATHERINE FAITH SHERBOURNE ADC-II, LICSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SHERBOURNE
Provider First Name:
CATHERINE
Provider Middle Name:
FAITH
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
ADC-II, LICSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SHERBOURNE
Provider Other First Name:
CAT
Provider Other Middle Name:
FAITH
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
LICSW
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1942842521
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/05/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
16025 SE 250TH CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
COVINGTON
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98042-4168
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
757-291-5765
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
16025 SE 250TH CT
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
COVINGTON
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98042-4168
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
757-291-5765
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/15/2019

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  LW61574264 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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