Provider Demographics
NPI:1962207514
Name:RADFORD, SEAN THOMAS
Entity type:Individual
Prefix:
First Name:SEAN
Middle Name:THOMAS
Last Name:RADFORD
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1531 WELLINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46219-3844
Mailing Address - Country:US
Mailing Address - Phone:317-414-6294
Mailing Address - Fax:
Practice Address - Street 1:1531 WELLINGTON AVE
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46219-3844
Practice Address - Country:US
Practice Address - Phone:317-414-6294
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-18
Last Update Date:2025-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health