Healthcare Provider Details

I. General information

NPI: 1699078295
Provider Name (Legal Business Name): SEAN MARTIN MARKEY ED.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/21/2010
Last Update Date: 07/18/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

124 WATERTOWN ST STE 2D
WATERTOWN MA
02472
US

IV. Provider business mailing address

124 WATERTOWN ST
WATERTOWN MA
02472-2576
US

V. Phone/Fax

Practice location:
  • Phone: 176-916-5069
  • Fax: 617-467-4073
Mailing address:
  • Phone: 508-838-2282
  • Fax: 508-838-2228

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number9282
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code103TH0100X
TaxonomyHealth Service Psychologist
License Number9282
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: