Provider Demographics
NPI:1225241599
Name:SHEHAN, LISA L (LSW)
Entity Type:Individual
Prefix:MRS
First Name:LISA
Middle Name:L
Last Name:SHEHAN
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:470 TOWNSHIP ROAD 1101
Mailing Address - Street 2:
Mailing Address - City:NOVA
Mailing Address - State:OH
Mailing Address - Zip Code:44859-9737
Mailing Address - Country:US
Mailing Address - Phone:419-652-2375
Mailing Address - Fax:419-281-4605
Practice Address - Street 1:470 TOWNSHIP ROAD 1101
Practice Address - Street 2:
Practice Address - City:NOVA
Practice Address - State:OH
Practice Address - Zip Code:44859-9737
Practice Address - Country:US
Practice Address - Phone:419-652-2375
Practice Address - Fax:419-281-4605
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-07
Last Update Date:2010-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X
OHS.0900977104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No171M00000XOther Service ProvidersCase Manager/Care Coordinator