Provider Demographics
NPI:1124509229
Name:SHEEHAN, CAROLE (AA)
Entity type:Individual
Prefix:MS
First Name:CAROLE
Middle Name:
Last Name:SHEEHAN
Suffix:
Gender:F
Credentials:AA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 REYNOLDS AVE APT 3
Mailing Address - Street 2:
Mailing Address - City:CORTLAND
Mailing Address - State:NY
Mailing Address - Zip Code:13045-2903
Mailing Address - Country:US
Mailing Address - Phone:518-354-0482
Mailing Address - Fax:
Practice Address - Street 1:380 FREEVILLE RD
Practice Address - Street 2:
Practice Address - City:FREEVILLE
Practice Address - State:NY
Practice Address - Zip Code:13068-9684
Practice Address - Country:US
Practice Address - Phone:607-844-6490
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-27
Last Update Date:2018-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)