Provider Demographics
NPI:1215417407
Name:MANSFIELD, SEAN M (LPC)
Entity type:Individual
Prefix:MR
First Name:SEAN
Middle Name:M
Last Name:MANSFIELD
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 COLUMBUS AVENUE
Mailing Address - Street 2:CREDENTIALING SPECIALIST
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06519-1233
Mailing Address - Country:US
Mailing Address - Phone:203-503-3174
Mailing Address - Fax:203-503-3183
Practice Address - Street 1:62 GRANT STREET
Practice Address - Street 2:GRANT STREET PARTNERSHIP
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06519-0651
Practice Address - Country:US
Practice Address - Phone:203-503-3350
Practice Address - Fax:203-503-3370
Is Sole Proprietor?:No
Enumeration Date:2018-08-16
Last Update Date:2018-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT3469101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004235918Medicaid