Basic Information
| Provider Information | |||||||||
| NPI: | 1003010034 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SHEEHAN | ||||||||
| FirstName: | MAUREEN | ||||||||
| MiddleName: | THERESA | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MSW LCSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 255 FIELDSTON TERRACE | ||||||||
| Address2: | |||||||||
| City: | BRONX | ||||||||
| State: | NY | ||||||||
| PostalCode: | 104713065 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7187966408 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 853 BROADWAY | ||||||||
| Address2: | SUITE 1201 | ||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100034717 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6462668712 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/13/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 071920 | NY | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.