Healthcare Provider Details

I. General information

NPI: 1346769734
Provider Name (Legal Business Name): PRESENCE SEALY COUNSELING AND DEVELOPMENT LICENSEDCLINICALSERVICESPLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/17/2017
Last Update Date: 11/01/2024
Certification Date: 11/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 FALL ST
SENECA FALLS NY
13148-1498
US

IV. Provider business mailing address

115 FALL ST
SENECA FALLS NY
13148-1498
US

V. Phone/Fax

Practice location:
  • Phone: 315-515-5183
  • Fax: 315-515-5194
Mailing address:
  • Phone: 315-515-5183
  • Fax: 315-515-5194

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberR036144-1
License Number StateNY

VIII. Authorized Official

Name: JAMEE M. SEALY
Title or Position: OWNER
Credential: LCSW-R
Phone: 315-568-8894