Provider Demographics
NPI:1053737965
Name:SHERYL LACOURSIERE LLC
Entity type:Organization
Organization Name:SHERYL LACOURSIERE LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SHERYL
Authorized Official - Middle Name:
Authorized Official - Last Name:LACOURSIERE
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, APRN
Authorized Official - Phone:203-264-8000
Mailing Address - Street 1:2 POMPERAUG OFFICE PARK STE 105
Mailing Address - Street 2:
Mailing Address - City:SOUTHBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06488-2289
Mailing Address - Country:US
Mailing Address - Phone:203-264-8000
Mailing Address - Fax:203-841-1246
Practice Address - Street 1:2 POMPERAUG OFFICE PARK STE 105
Practice Address - Street 2:
Practice Address - City:SOUTHBURY
Practice Address - State:CT
Practice Address - Zip Code:06488-2289
Practice Address - Country:US
Practice Address - Phone:203-264-8000
Practice Address - Fax:203-841-1246
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-16
Last Update Date:2020-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103TP0016X
CT3861363LF0000X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty
No103TP0016XBehavioral Health & Social Service ProvidersPsychologistPrescribing (Medical)Group - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty