Provider Demographics
NPI:1093921470
Name:SHEEHAN, LILLIAN (LCPC)
Entity Type:Individual
Prefix:
First Name:LILLIAN
Middle Name:
Last Name:SHEEHAN
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:828 AIRPAX RD
Mailing Address - Street 2:STE 300 BLDG B
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MD
Mailing Address - Zip Code:21617
Mailing Address - Country:US
Mailing Address - Phone:410-228-3929
Mailing Address - Fax:410-228-3810
Practice Address - Street 1:152 COURSEVAL DRIVE
Practice Address - Street 2:STE 142
Practice Address - City:CENTREVILLE
Practice Address - State:MD
Practice Address - Zip Code:21617
Practice Address - Country:US
Practice Address - Phone:410-228-3929
Practice Address - Fax:410-228-3810
Is Sole Proprietor?:No
Enumeration Date:2007-05-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LC23491041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD836LMedicare ID - Type Unspecified