Healthcare Provider Details

I. General information

NPI: 1609371103
Provider Name (Legal Business Name): SEBASTIAN PUTZEYS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/27/2018
Last Update Date: 06/22/2021
Certification Date: 06/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 BOSTON ST
SALEM MA
01970-1402
US

IV. Provider business mailing address

15 BLUEBERRY LN
SCITUATE MA
02066-2443
US

V. Phone/Fax

Practice location:
  • Phone: 617-894-7363
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number12288
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: