Healthcare Provider Details

I. General information

NPI: 1609230945
Provider Name (Legal Business Name): JENNIFER O'SHEA LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/13/2016
Last Update Date: 12/20/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2005 CABOT BLVD W STE 100
LANGHORNE PA
19047-1898
US

IV. Provider business mailing address

17 W KNIGHT AVE
COLLINGSWOOD NJ
08108-1476
US

V. Phone/Fax

Practice location:
  • Phone: 267-587-2300
  • Fax:
Mailing address:
  • Phone: 877-636-9322
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCW019084
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: