Healthcare Provider Details

I. General information

NPI: 1083805998
Provider Name (Legal Business Name): SEAN SEWARD-KATZMILLER MFT INTERN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/06/2007
Last Update Date: 12/01/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1501 FRUITVALE AVE
OAKLAND CA
94601-2322
US

IV. Provider business mailing address

1501 FRUITVALE AVE
OAKLAND CA
94601-2322
US

V. Phone/Fax

Practice location:
  • Phone: 510-535-6200
  • Fax: 510-535-4167
Mailing address:
  • Phone: 510-535-6200
  • Fax: 510-535-4167

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number57818
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberLMFT52687
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: