Healthcare Provider Details

I. General information

NPI: 1114343035
Provider Name (Legal Business Name): PATRICIA JUNE SEAVER MSW-LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/17/2014
Last Update Date: 03/17/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 INDIAN DAWN
WAYLAND MA
01778-3920
US

IV. Provider business mailing address

2 INDIAN DAWN
WAYLAND MA
01778-3920
US

V. Phone/Fax

Practice location:
  • Phone: 508-276-1559
  • Fax:
Mailing address:
  • Phone: 508-276-1559
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number105402
License Number StateMA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier105402
Identifier TypeOTHER
Identifier StateMA
Identifier IssuerLICSW

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: