Provider Demographics
NPI:1528410438
Name:SHEERAN, KELLY (CASAC)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:
Last Name:SHEERAN
Suffix:
Gender:F
Credentials:CASAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:56 BAY ST
Mailing Address - Street 2:6TH FLOOR
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10301-2563
Mailing Address - Country:US
Mailing Address - Phone:718-808-1439
Mailing Address - Fax:718-808-1393
Practice Address - Street 1:56 BAY ST
Practice Address - Street 2:6TH FLOOR
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10301-2563
Practice Address - Country:US
Practice Address - Phone:718-808-1439
Practice Address - Fax:718-808-1393
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-05
Last Update Date:2016-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)