Provider Demographics
NPI:1417947219
Name:SHEEHAN, TIMOTHY JUDE (LCSW)
Entity Type:Individual
Prefix:MR
First Name:TIMOTHY
Middle Name:JUDE
Last Name:SHEEHAN
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2290 EAST AVE
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14610-2518
Mailing Address - Country:US
Mailing Address - Phone:585-325-6370
Mailing Address - Fax:585-889-0103
Practice Address - Street 1:2290 EAST AVE
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14610-2518
Practice Address - Country:US
Practice Address - Phone:585-325-6370
Practice Address - Fax:585-889-0103
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR033697-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY10144BMedicare ID - Type Unspecified