Healthcare Provider Details

I. General information

NPI: 1760055511
Provider Name (Legal Business Name): SEAN PATRICK O'HARA LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/20/2021
Last Update Date: 07/25/2025
Certification Date: 07/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

62 PROVOST DR
WINDHAM ME
04062-5095
US

IV. Provider business mailing address

62 PROVOST DR
WINDHAM ME
04062-5095
US

V. Phone/Fax

Practice location:
  • Phone: 516-547-7367
  • Fax:
Mailing address:
  • Phone: 516-547-7367
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLC20437
License Number StateME
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number091423
License Number StateNY

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: