Provider Demographics
NPI:1720237266
Name:J MARK OSHEA INC
Entity Type:Organization
Organization Name:J MARK OSHEA INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LCSW
Authorized Official - Prefix:
Authorized Official - First Name:J.
Authorized Official - Middle Name:MARK
Authorized Official - Last Name:O'SHEA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:804-744-5611
Mailing Address - Street 1:4906 MILLRIDGE PKWY E
Mailing Address - Street 2:
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:VA
Mailing Address - Zip Code:23112-4828
Mailing Address - Country:US
Mailing Address - Phone:804-744-5611
Mailing Address - Fax:804-739-1691
Practice Address - Street 1:4906 MILLRIDGE PKWY E
Practice Address - Street 2:
Practice Address - City:MIDLOTHIAN
Practice Address - State:VA
Practice Address - Zip Code:23112-4828
Practice Address - Country:US
Practice Address - Phone:804-744-5611
Practice Address - Fax:804-739-1691
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-09
Last Update Date:2008-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040016381041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010026997Medicaid
VAC08917Medicare PIN
VAC08917Medicare UPIN