=====================================================
General NPI Number Information
=====================================================
NPI Number | 1437708690
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SHERRI L. O'SHEA LCSW LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/10/2019
-----------------------------------------------------
Last Update Date | 09/10/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 770 SAYBROOK RD BLDG B
-----------------------------------------------------
City | MIDDLETOWN
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06457-4739
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 860-338-1750
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 32 MYRTLE RD
-----------------------------------------------------
City | PORTLAND
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06480-1623
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 860-338-1750
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | SOCIAL WORKER
-----------------------------------------------------
Name | MRS. SHERRI L O'SHEA
-----------------------------------------------------
Credential | LCSW
-----------------------------------------------------
Telephone | 860-338-1750
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------