MEDICARE: DR. BRIDGET MARTIN SHEAHAN PSY.D.

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
1	103TC0700X	Clinical Psychologist	01884	MO
2	103TH0100X	Health Service Psychologist	01884	MO

General Provider Information

NPI Number	:	1770991762
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BRIDGET MARTIN SHEAHAN PSY.D.

Provider Business Mailing Address
First Line	:	2821 NORTH BALLAS ROAD, SUITE C-39
Second Line	:	TOWN AND COUNTRY MEDICAL BUILDING
City	:	ST. LOUIS
State	:	MO
Zip	:	63131
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2821 NORTH BALLAS ROA
Second Line	:	SUITE C-39 TOWN AND COUNTRY MEDICAL BUILDING
City	:	ST. LOUIS
State	:	MO
Zip	:	63131-2313
Country	:	US
Telephone Number	:	314-997-0945
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/23/2014
Last Update Date	:	07/29/2014

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