Healthcare Provider Details

I. General information

NPI: 1265485080
Provider Name (Legal Business Name): JEFFREY SEWARD LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/19/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 BEEKMAN ST
NEW YORK NY
10038-1810
US

IV. Provider business mailing address

100 BEEKMAN ST
NEW YORK NY
10038-1805
US

V. Phone/Fax

Practice location:
  • Phone: 212-619-6354
  • Fax:
Mailing address:
  • Phone: 212-619-6354
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number056409
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: