Provider Demographics
NPI:1619902327
Name:SHEEHAN, JACQUELINE R (PHD)
Entity Type:Individual
Prefix:DR
First Name:JACQUELINE
Middle Name:R
Last Name:SHEEHAN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:37 BERKSHIRE TER
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:MA
Mailing Address - Zip Code:01062-1913
Mailing Address - Country:US
Mailing Address - Phone:413-582-0661
Mailing Address - Fax:
Practice Address - Street 1:509 SOUTHWICK RD
Practice Address - Street 2:
Practice Address - City:WESTFIELD
Practice Address - State:MA
Practice Address - Zip Code:01085-4734
Practice Address - Country:US
Practice Address - Phone:413-562-1011
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA7081103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling