Provider Demographics
NPI:1174297154
Name:SHEERAN, ROBERT K (LADC II)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:K
Last Name:SHEERAN
Suffix:
Gender:M
Credentials:LADC II
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23 BRADSTON ST
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02118-2703
Mailing Address - Country:US
Mailing Address - Phone:617-318-6480
Mailing Address - Fax:
Practice Address - Street 1:23 BRADSTON ST
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02118-2703
Practice Address - Country:US
Practice Address - Phone:617-318-6480
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-04
Last Update Date:2021-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2273101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)