Provider Demographics
NPI:1285996017
Name:GOING, SEAN MATTHEW (LAC)
Entity type:Individual
Prefix:
First Name:SEAN
Middle Name:MATTHEW
Last Name:GOING
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:10 HARBOR VW N
Mailing Address - Street 2:
Mailing Address - City:ESSEX
Mailing Address - State:CT
Mailing Address - Zip Code:06426-1447
Mailing Address - Country:US
Mailing Address - Phone:860-304-9270
Mailing Address - Fax:866-577-3406
Practice Address - Street 1:3 WILDWOOD MEDICAL CTR
Practice Address - Street 2:35 SAYBROOK ROAD
Practice Address - City:ESSEX
Practice Address - State:CT
Practice Address - Zip Code:06426-1155
Practice Address - Country:US
Practice Address - Phone:860-767-0888
Practice Address - Fax:860-577-3406
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-07
Last Update Date:2012-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000538171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist