Provider Demographics
NPI:1285425579
Name:SHEHAN, DOUGLAS (LCDP)
Entity type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:
Last Name:SHEHAN
Suffix:
Gender:M
Credentials:LCDP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1020 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:CRANSTON
Mailing Address - State:RI
Mailing Address - Zip Code:02910-3227
Mailing Address - Country:US
Mailing Address - Phone:401-396-7649
Mailing Address - Fax:
Practice Address - Street 1:1020 PARK AVE
Practice Address - Street 2:
Practice Address - City:CRANSTON
Practice Address - State:RI
Practice Address - Zip Code:02910-3227
Practice Address - Country:US
Practice Address - Phone:401-396-7649
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-15
Last Update Date:2025-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)