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NPI Code Detail

MEDICARE: MR. TIMOTHY JUDE SHEEHAN LCSW

MEDICARE: MR. TIMOTHY JUDE SHEEHAN LCSW
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11041C0700XClinical Social WorkerR033697-1NY

General Provider Information

NPI Number : 1417947219
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. TIMOTHY JUDE SHEEHAN LCSW
Provider Business Mailing Address
First Line : 2290 EAST AVE
Second Line :
City : ROCHESTER
State : NY
Zip : 14610-2518
Country : US
Telephone Number : 585-325-6370
Fax Number : 585-889-0103
Provider Business Practice Location Address
First Line : 2290 EAST AVE
Second Line :
City : ROCHESTER
State : NY
Zip : 14610-2518
Country : US
Telephone Number : 585-325-6370
Fax Number : 585-889-0103
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/24/2005
Last Update Date : 07/08/2007

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