Healthcare Provider Details

I. General information

NPI: 1023533296
Provider Name (Legal Business Name): SALVATORE SEELEY III LCSW-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/09/2017
Last Update Date: 07/15/2026
Certification Date: 07/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1404 W LOMBARD ST
BALTIMORE MD
21223-3137
US

IV. Provider business mailing address

1404 W LOMBARD ST
BALTIMORE MD
21223-3137
US

V. Phone/Fax

Practice location:
  • Phone: 302-270-5503
  • Fax:
Mailing address:
  • Phone: 302-270-5503
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number14888
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: