Healthcare Provider Details

I. General information

NPI: 1336696913
Provider Name (Legal Business Name): ERIN SEERY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/01/2016
Last Update Date: 09/01/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 MAIN STREET
STOCKBRIDGE MA
01262-0962
US

IV. Provider business mailing address

1 COOL BLOW ST APT 138
CHARLESTON SC
29403-4272
US

V. Phone/Fax

Practice location:
  • Phone: 413-931-5831
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0805X
TaxonomyGeriatric Psychiatry Physician
License Number258888
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number258888
License Number StateMA

VIII. Authorized Official

Name: ERIN SEERY
Title or Position: AUTORIZED OFFICIAL
Credential: M.D.
Phone: 814-207-3931