Provider Demographics
NPI:1720693211
Name:DUANE, SEAN CONNOR
Entity type:Individual
Prefix:MR
First Name:SEAN
Middle Name:CONNOR
Last Name:DUANE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4199 LANARK RD
Mailing Address - Street 2:
Mailing Address - City:CENTER VALLEY
Mailing Address - State:PA
Mailing Address - Zip Code:18034-9590
Mailing Address - Country:US
Mailing Address - Phone:610-791-4724
Mailing Address - Fax:
Practice Address - Street 1:11150 SUNSET HILLS RD
Practice Address - Street 2:
Practice Address - City:RESTON
Practice Address - State:VA
Practice Address - Zip Code:20190-5360
Practice Address - Country:US
Practice Address - Phone:703-471-5517
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-10
Last Update Date:2020-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty