Provider Demographics
NPI:1306286570
Name:SHEEHAN, LISA (PHD)
Entity type:Individual
Prefix:DR
First Name:LISA
Middle Name:
Last Name:SHEEHAN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2324 W JOPPA RD STE 420
Mailing Address - Street 2:
Mailing Address - City:LUTHERVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21093-4620
Mailing Address - Country:US
Mailing Address - Phone:443-330-2146
Mailing Address - Fax:410-321-9537
Practice Address - Street 1:2324 W JOPPA RD STE 420
Practice Address - Street 2:
Practice Address - City:LUTHERVILLE
Practice Address - State:MD
Practice Address - Zip Code:21093-4620
Practice Address - Country:US
Practice Address - Phone:443-330-2146
Practice Address - Fax:410-321-9537
Is Sole Proprietor?:No
Enumeration Date:2013-07-02
Last Update Date:2013-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD03465103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical