Provider Demographics
NPI:1770813123
Name:SHEEHAN, ELLEN M
Entity type:Individual
Prefix:
First Name:ELLEN
Middle Name:M
Last Name:SHEEHAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ELLEN
Other - Middle Name:
Other - Last Name:KEATING
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:28 GEORGE WASHINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:HINGHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02043-1002
Mailing Address - Country:US
Mailing Address - Phone:781-749-7000
Mailing Address - Fax:781-740-8390
Practice Address - Street 1:28 GEORGE WASHINGTON BLVD
Practice Address - Street 2:
Practice Address - City:HINGHAM
Practice Address - State:MA
Practice Address - Zip Code:02043-1002
Practice Address - Country:US
Practice Address - Phone:781-749-7000
Practice Address - Fax:781-740-8390
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-07
Last Update Date:2010-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10287561041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical