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General NPI Number Information
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NPI Number | 1215685219
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Entity Type | Individual
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Provider Name | SEAN RANDALL ANTHONY M.M.H.S.; MSED, LPC
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Gender | Male
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Dates
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Enumeration Date | 03/17/2022
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Last Update Date | 03/17/2022
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Provider Practice Location Address
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Address Line | 601 W CLIVEDEN ST
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City | PHILADELPHIA
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State | PA
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Zip | 19119-3652
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Country | US
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Telephone | 856-577-3860
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Fax |
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Provider Business Mailing Address
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Address Line | 64 COACHLIGHT DR
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City | SICKLERVILLE
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State | NJ
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Zip | 08081-5608
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Country | US
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Telephone | 215-607-7624
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | PC014246
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License Number State | PA
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