Provider Demographics
NPI:1639110828
Name:O'HALLORAN, SHARON A (LICSW)
Entity Type:Individual
Prefix:
First Name:SHARON
Middle Name:A
Last Name:O'HALLORAN
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6307 OVERLAND DR
Mailing Address - Street 2:
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33484-1575
Mailing Address - Country:US
Mailing Address - Phone:561-450-7761
Mailing Address - Fax:
Practice Address - Street 1:6307 OVERLAND DR
Practice Address - Street 2:
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33484-1575
Practice Address - Country:US
Practice Address - Phone:561-450-7761
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2012-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA105207104100000X
FL106951041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAP03667OtherBLUE CROSS
MAP23367Medicare ID - Type Unspecified