=====================================================
General NPI Number Information
=====================================================
NPI Number | 1689272890
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SHEEHAN JOSEPH LCSW
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/12/2020
-----------------------------------------------------
Last Update Date | 10/12/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 91 N 48TH ST
-----------------------------------------------------
City | PHILA
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19139-2837
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 917-647-0026
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 516 REVERE RD
-----------------------------------------------------
City | MERION STATION
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19066-1043
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 917-647-0026
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | CW020582
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------