Provider Demographics
NPI:1770991762
Name:SHEAHAN, BRIDGET MARTIN (PSYD)
Entity type:Individual
Prefix:DR
First Name:BRIDGET
Middle Name:MARTIN
Last Name:SHEAHAN
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:DR
Other - First Name:BRIDGET
Other - Middle Name:K
Other - Last Name:MARTIN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PSYD
Mailing Address - Street 1:2821 NORTH BALLAS ROAD, SUITE C-39
Mailing Address - Street 2:TOWN AND COUNTRY MEDICAL BUILDING
Mailing Address - City:ST. LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63131
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2821 NORTH BALLAS ROA
Practice Address - Street 2:SUITE C-39 TOWN AND COUNTRY MEDICAL BUILDING
Practice Address - City:ST. LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63131-2313
Practice Address - Country:US
Practice Address - Phone:314-997-0945
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-23
Last Update Date:2014-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO01884103TC0700X, 103TH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TH0100XBehavioral Health & Social Service ProvidersPsychologistHealth Service