Provider Demographics
NPI:1164811006
Name:SHEEHAN, JESSICA J
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:J
Last Name:SHEEHAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:46 ACUSHNET RD
Mailing Address - Street 2:
Mailing Address - City:MATTAPOISETT
Mailing Address - State:MA
Mailing Address - Zip Code:02739-1532
Mailing Address - Country:US
Mailing Address - Phone:781-422-1457
Mailing Address - Fax:508-771-3287
Practice Address - Street 1:1 HIGH ST
Practice Address - Street 2:
Practice Address - City:MIDDLEBORO
Practice Address - State:MA
Practice Address - Zip Code:02346
Practice Address - Country:US
Practice Address - Phone:508-830-3444
Practice Address - Fax:508-830-3434
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-15
Last Update Date:2018-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1164811006Medicaid