Healthcare Provider Details

I. General information

NPI: 1477856490
Provider Name (Legal Business Name): MAUREEN DAY O'SHEA LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/14/2010
Last Update Date: 12/14/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

36 BRIDGE WAY
PASCOAG RI
02859-3131
US

IV. Provider business mailing address

36 BRIDGE WAY PO BOX 312
PASCOAG RI
02859-3131
US

V. Phone/Fax

Practice location:
  • Phone: 401-568-7661
  • Fax: 401-371-2907
Mailing address:
  • Phone: 401-568-7661
  • Fax: 401-371-2907

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMHC00353
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: