Healthcare Provider Details

I. General information

NPI: 1417947219
Provider Name (Legal Business Name): TIMOTHY JUDE SHEEHAN LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/24/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2290 EAST AVE
ROCHESTER NY
14610-2518
US

IV. Provider business mailing address

2290 EAST AVE
ROCHESTER NY
14610-2518
US

V. Phone/Fax

Practice location:
  • Phone: 585-325-6370
  • Fax: 585-889-0103
Mailing address:
  • Phone: 585-325-6370
  • Fax: 585-889-0103

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberR033697-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: