Provider Demographics
NPI:1427531110
Name:SHEAHAN, SAMANTHA MARIE (LPCC, RDT)
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:MARIE
Last Name:SHEAHAN
Suffix:
Gender:F
Credentials:LPCC, RDT
Other - Prefix:
Other - First Name:SAMIRA
Other - Middle Name:
Other - Last Name:SHEAHAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RDT
Mailing Address - Street 1:PO BOX 9284
Mailing Address - Street 2:
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94709-0284
Mailing Address - Country:US
Mailing Address - Phone:510-701-0385
Mailing Address - Fax:
Practice Address - Street 1:2484 SHATTUCK AVE STE 210
Practice Address - Street 2:
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94704-2076
Practice Address - Country:US
Practice Address - Phone:925-644-7512
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-10
Last Update Date:2024-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RDT850101200000X
CALPCC17565101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101200000XBehavioral Health & Social Service ProvidersDrama Therapist