Provider Demographics
NPI:1922149269
Name:O'HARA, SEAN (PSYD,CADC II,SAP)
Entity Type:Individual
Prefix:
First Name:SEAN
Middle Name:
Last Name:O'HARA
Suffix:
Gender:M
Credentials:PSYD,CADC II,SAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7200 PARKWAY DR
Mailing Address - Street 2:SUITE 113
Mailing Address - City:LA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:91942-1534
Mailing Address - Country:US
Mailing Address - Phone:619-589-0552
Mailing Address - Fax:619-589-0205
Practice Address - Street 1:7200 PARKWAY DR
Practice Address - Street 2:SUITE 113
Practice Address - City:LA MESA
Practice Address - State:CA
Practice Address - Zip Code:91942-1534
Practice Address - Country:US
Practice Address - Phone:619-589-0552
Practice Address - Fax:619-589-0205
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY19909103TA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TA0400XBehavioral Health & Social Service ProvidersPsychologistAddiction (Substance Use Disorder)