Provider Demographics
NPI:1477520740
Name:SHEEHAN, DAVID VINCENT (LICSW)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:VINCENT
Last Name:SHEEHAN
Suffix:
Gender:M
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:47 YOULE ST
Mailing Address - Street 2:
Mailing Address - City:MELROSE
Mailing Address - State:MA
Mailing Address - Zip Code:02176-2625
Mailing Address - Country:US
Mailing Address - Phone:781-662-7287
Mailing Address - Fax:
Practice Address - Street 1:533 MAIN ST
Practice Address - Street 2:#7
Practice Address - City:MELROSE
Practice Address - State:MA
Practice Address - Zip Code:02176-3858
Practice Address - Country:US
Practice Address - Phone:781-662-2562
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-04
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1010041041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA550010005436OtherPACIFICA ID#
MA1853571Medicaid
MAP01598OtherBC/BS MASS.
MAP01598OtherBC/BS MASS.