Provider Demographics
NPI:1285040600
Name:BEDFORD, SEAN (LMHC)
Entity type:Individual
Prefix:
First Name:SEAN
Middle Name:
Last Name:BEDFORD
Suffix:
Gender:M
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 PARKVILLE AVE
Mailing Address - Street 2:APT 8D
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11230-1483
Mailing Address - Country:US
Mailing Address - Phone:917-267-8393
Mailing Address - Fax:
Practice Address - Street 1:210 PARKVILLE AVE
Practice Address - Street 2:APT 8D
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11230-1483
Practice Address - Country:US
Practice Address - Phone:917-267-8393
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-07
Last Update Date:2024-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010771101YM0800X
322D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children