Active NPI
Sherrie Thang Waller, LCSW
- Clinical Social Worker
- Jackson Heights, NY
National Provider Identifier
1497270466
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 091962
- Practice address
- 3421 78TH St Apt 6I
Jackson Heights, NY 11372-2514 - Phone
- (347) 201-0249
- NPI assigned
- Aug 10, 2017
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 091962 | NY | Primary |
Addresses
Primary practice location
3421 78TH St Apt 6I
Jackson Heights, NY 11372-2514
Mailing address
3421 78TH St Apt 6I
Jackson Heights, NY 11372-2514
Phone (347) 201-0249
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 091962 | NY | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1502323200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1761782400000",
"number": "1497270466",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3421 78TH ST APT 6I",
"city": "JACKSON HEIGHTS",
"state": "NY",
"postal_code": "113722514",
"telephone_number": "347-201-0249"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3421 78TH ST APT 6I",
"city": "JACKSON HEIGHTS",
"state": "NY",
"postal_code": "113722514",
"telephone_number": "347-201-0249"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WALLER",
"first_name": "SHERRIE",
"middle_name": "THANG",
"credential": "LCSW",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2017-08-10",
"last_updated": "2025-10-30",
"certification_date": "2025-10-30",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "NY",
"license": "091962",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Jackson Heights, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 30, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.