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General NPI Number Information
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NPI Number | 1790230209
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Entity Type | Organization
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Legal Business Name | KEVIN O'SHEA, PSYD LLC
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Dates
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Enumeration Date | 08/25/2016
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Last Update Date | 06/19/2023
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Provider Practice Location Address
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Address Line | 769 NEWFIELD ST. STE. 8
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City | MIDDLETOWN
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State | CT
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Zip | 06457
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Country | US
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Telephone | 860-759-0664
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Fax |
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Provider Business Mailing Address
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Address Line | 769 NEWFIELD ST. STE. 8
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City | MIDDLETOWN
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State | CT
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Zip | 06457
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Country | US
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Telephone | 860-759-0664
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Fax |
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Authorized Official
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Title or Position | SOLE PROPRIETOR/OWNER
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Name | DR. KEVIN MICHAEL O'SHEA
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Credential | PSYD
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Telephone | 860-759-0664
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 003064
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License Number State | CT
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