Healthcare Provider Details

I. General information

NPI: 1548308927
Provider Name (Legal Business Name): JOHN ROGER SEBASTIANELLI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/01/2007
Last Update Date: 04/11/2023
Certification Date: 04/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

76 SUMMER ST
HAVERHILL MA
01830-5814
US

IV. Provider business mailing address

76 SUMMER ST
HAVERHILL MA
01830-5814
US

V. Phone/Fax

Practice location:
  • Phone: 781-373-8222
  • Fax: 978-373-8223
Mailing address:
  • Phone: 978-373-8222
  • Fax: 978-373-8223

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TP0016X
TaxonomyPrescribing (Medical) Psychologist
License Number71571
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number71571
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: