Healthcare Provider Details

I. General information

NPI: 1285040600
Provider Name (Legal Business Name): SEAN BEDFORD LMHC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/07/2014
Last Update Date: 10/09/2024
Certification Date: 10/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 PARKVILLE AVE APT 8D
BROOKLYN NY
11230-1483
US

IV. Provider business mailing address

210 PARKVILLE AVE APT 8D
BROOKLYN NY
11230-1483
US

V. Phone/Fax

Practice location:
  • Phone: 917-267-8393
  • Fax:
Mailing address:
  • Phone: 917-267-8393
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number010771
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code322D00000X
TaxonomyEmotionally Disturbed Childrens' Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: