=====================================================
General NPI Number Information
=====================================================
NPI Number | 1710116702
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | THERESA SEWARD MS, LCPC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/10/2009
-----------------------------------------------------
Last Update Date | 12/04/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 231 YORK ST
-----------------------------------------------------
City | PORTLAND
-----------------------------------------------------
State | ME
-----------------------------------------------------
Zip | 04102-3953
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 207-329-2366
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 11 CHARLES RD
-----------------------------------------------------
City | CAPE ELIZABETH
-----------------------------------------------------
State | ME
-----------------------------------------------------
Zip | 04107-1306
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 207-329-2366
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number | CC4142
-----------------------------------------------------
License Number State | ME
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number | CC4142
-----------------------------------------------------
License Number State | ME
-----------------------------------------------------