Healthcare Provider Details

I. General information

NPI: 1922470954
Provider Name (Legal Business Name): ABBY SEAR LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/29/2015
Last Update Date: 06/11/2020
Certification Date: 06/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31 INDUSTRIAL BLVD
MEDFORD NY
11763-2220
US

IV. Provider business mailing address

31 INDUSTRIAL BLVD
MEDFORD NY
11763-2220
US

V. Phone/Fax

Practice location:
  • Phone: 631-924-4411
  • Fax:
Mailing address:
  • Phone: 631-924-4411
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number087919-1
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number085758-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: