Provider Demographics
NPI:1104946110
Name:TIPPY, MARGARET O'SHEA (PSYD)
Entity type:Individual
Prefix:DR
First Name:MARGARET
Middle Name:O'SHEA
Last Name:TIPPY
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:DR
Other - First Name:MARGARET
Other - Middle Name:
Other - Last Name:O'SHEA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PSYD
Mailing Address - Street 1:1407 SCHAEFFER ROAD
Mailing Address - Street 2:
Mailing Address - City:SEBASTOPOL
Mailing Address - State:CA
Mailing Address - Zip Code:95472-5542
Mailing Address - Country:US
Mailing Address - Phone:707-237-5209
Mailing Address - Fax:
Practice Address - Street 1:222 STATION PLZ N STE 250A
Practice Address - Street 2:
Practice Address - City:MINEOLA
Practice Address - State:NY
Practice Address - Zip Code:11501-3893
Practice Address - Country:US
Practice Address - Phone:516-663-2691
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-31
Last Update Date:2022-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY014821103T00000X
CA27044103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist