=====================================================
General NPI Number Information
=====================================================
NPI Number | 1033356092
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MAUREEN T. SHEA LMSW PSYCHOLOGIST PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/13/2009
-----------------------------------------------------
Last Update Date | 09/02/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 586 RT 25A
-----------------------------------------------------
City | ROCKY POINT
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11778-7006
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 631-929-0691
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 250 CALVES NECK RD
-----------------------------------------------------
City | SOUTHOLD
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11971-1210
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 631-765-4397
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. MAUREEN T. SHEA
-----------------------------------------------------
Credential | PH.D.
-----------------------------------------------------
Telephone | 631-765-4397
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103TC0700X
-----------------------------------------------------
Taxonomy Name | Clinical Psychologist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------