Provider Information for 1053562165
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TARA ANN O'SHEA LCSW, CAP
Sex: Female
NPI: 1053562165
Last Updated: 2020-06-25
Certification Date: 2020-06-25
Certification Date: 2020-06-25
Details
| Name | Value | ||||||||||||
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| NPI | 1053562165 | ||||||||||||
| Enumeration Date | 2008-10-07 | ||||||||||||
| NPI Type | NPI-1 Individual | ||||||||||||
| Sole Proprietor | NO | ||||||||||||
| Status | Active | ||||||||||||
| Mailing Address | 7103 BROOKLINE AVE FORT PIERCE, FL 34951-1206 United States Phone: 615-523-4574 | Fax: | ||||||||||||
| Primary Practice Address | 519 S PARK AVE SANFORD, FL 32771-1934 United States Phone: 321-209-4040 | Fax: | ||||||||||||
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