Provider Demographics
NPI:1679287965
Name:SHARLOW, AVERY G (LMCSW)
Entity type:Individual
Prefix:
First Name:AVERY
Middle Name:G
Last Name:SHARLOW
Suffix:
Gender:F
Credentials:LMCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:214 KING STREET
Mailing Address - Street 2:
Mailing Address - City:OGDENSBURG
Mailing Address - State:NY
Mailing Address - Zip Code:13669
Mailing Address - Country:US
Mailing Address - Phone:315-713-5720
Mailing Address - Fax:315-713-5741
Practice Address - Street 1:214 KING STREET
Practice Address - Street 2:
Practice Address - City:OGDENSBURG
Practice Address - State:NY
Practice Address - Zip Code:13669
Practice Address - Country:US
Practice Address - Phone:315-713-5720
Practice Address - Fax:315-713-5741
Is Sole Proprietor?:No
Enumeration Date:2023-01-11
Last Update Date:2024-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY121645104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker