Provider Demographics
NPI:1659843720
Name:SHEEHAN, JOHN EUGENE (LMSW)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:EUGENE
Last Name:SHEEHAN
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:432 W 56TH ST APT 1I
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10019-7807
Mailing Address - Country:US
Mailing Address - Phone:646-382-5019
Mailing Address - Fax:
Practice Address - Street 1:432 W 56TH ST APT 1I
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10019-7807
Practice Address - Country:US
Practice Address - Phone:646-382-5019
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-29
Last Update Date:2018-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0428364104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0428364OtherLMSW LICENSE