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NPI Code Detail

MEDICARE: KERRY LEE SHEEHAN L.M.S.W

MEDICARE: KERRY LEE SHEEHAN L.M.S.W
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
1104100000XSocial Worker41426TX

General Provider Information

NPI Number : 1881961704
Entity Type Code : Individual
Provider Name (Legal Business Name) : KERRY LEE SHEEHAN L.M.S.W
Provider Business Mailing Address
First Line : 2824 REAL ST
Second Line :
City : AUSTIN
State : TX
Zip : 78722-1715
Country : US
Telephone Number : 512-788-5678
Fax Number :
Provider Business Practice Location Address
First Line : 2824 REAL ST
Second Line :
City : AUSTIN
State : TX
Zip : 78722-1715
Country : US
Telephone Number : 512-788-5678
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/21/2011
Last Update Date : 11/21/2011

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