1427501600 NPI number — JUDITH A. SEALEY LADC I, CAS, CCCJS

Table of content: JUDITH A. SEALEY LADC I, CAS, CCCJS (NPI 1427501600)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1427501600 NPI number — JUDITH A. SEALEY LADC I, CAS, CCCJS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SEALEY
Provider First Name:
JUDITH
Provider Middle Name:
A.
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LADC I, CAS, CCCJS
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1427501600
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/25/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1400 HANCOCK ST
Provider Second Line Business Mailing Address:
2ND FLR
Provider Business Mailing Address City Name:
QUINCY
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02169-5233
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
617-774-0331
Provider Business Mailing Address Fax Number:
617-774-0336

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1400 HANCOCK ST
Provider Second Line Business Practice Location Address:
2ND FLR
Provider Business Practice Location Address City Name:
QUINCY
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02169-5233
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
617-774-0331
Provider Business Practice Location Address Fax Number:
617-774-0336
Provider Enumeration Date:
07/25/2016

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YA0400X , with the licence number:  183 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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