Provider Demographics
NPI:1215685219
Name:ANTHONY, SEAN RANDALL (MMHS; MSED, LPC)
Entity type:Individual
Prefix:
First Name:SEAN
Middle Name:RANDALL
Last Name:ANTHONY
Suffix:
Gender:M
Credentials:MMHS; MSED, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:64 COACHLIGHT DR
Mailing Address - Street 2:
Mailing Address - City:SICKLERVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08081-5608
Mailing Address - Country:US
Mailing Address - Phone:215-607-7624
Mailing Address - Fax:
Practice Address - Street 1:601 W CLIVEDEN ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19119-3652
Practice Address - Country:US
Practice Address - Phone:856-577-3860
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-17
Last Update Date:2022-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC014246101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional