Provider Demographics
NPI:1356119937
Name:SHEEHAN, LISA
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:SHEEHAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12440 MAC ALISTER WAY UNIT 101
Mailing Address - Street 2:
Mailing Address - City:NEW BERLIN
Mailing Address - State:WI
Mailing Address - Zip Code:53151-8326
Mailing Address - Country:US
Mailing Address - Phone:954-477-1700
Mailing Address - Fax:
Practice Address - Street 1:12440 MAC ALISTER WAY UNIT 101
Practice Address - Street 2:
Practice Address - City:NEW BERLIN
Practice Address - State:WI
Practice Address - Zip Code:53151-8326
Practice Address - Country:US
Practice Address - Phone:954-477-1700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-13
Last Update Date:2023-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCAP.0005853101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty