Provider Demographics
NPI:1629217989
Name:SHEEHAN, KATHLEEN MARY (LCSW)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:MARY
Last Name:SHEEHAN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10328 BIG THICKET DR
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78747-2706
Mailing Address - Country:US
Mailing Address - Phone:512-289-1914
Mailing Address - Fax:512-551-3467
Practice Address - Street 1:10328 BIG THICKET DR
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78747-2706
Practice Address - Country:US
Practice Address - Phone:512-665-3075
Practice Address - Fax:512-551-3467
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-10
Last Update Date:2013-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX27523101YM0800X, 104100000X, 1041C0700X, 171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXTXB115692OtherMEDICARE PTAN
TX040582103Medicaid