Basic Information
| Provider Information | |||||||||
| NPI: | 1710137161 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SHERIDAN | ||||||||
| FirstName: | RICHARD | ||||||||
| MiddleName: | DOUGLAS | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MA, PLMHP, PCMSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2201 S 17TH ST | ||||||||
| Address2: | |||||||||
| City: | LINCOLN | ||||||||
| State: | NE | ||||||||
| PostalCode: | 685023713 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4024417940 | ||||||||
| FaxNumber: | 4024418625 | ||||||||
| Practice Location | |||||||||
| Address1: | 2201 S 17TH ST | ||||||||
| Address2: | |||||||||
| City: | LINCOLN | ||||||||
| State: | NE | ||||||||
| PostalCode: | 685023713 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4024417940 | ||||||||
| FaxNumber: | 4024418625 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/23/2008 | ||||||||
| LastUpdateDate: | 01/03/2012 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 9564 | NE | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.