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General NPI Number Information
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NPI Number | 1730902842
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Entity Type | Individual
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Provider Name | SEAN PAUL CARLETON
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Gender | Male
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Dates
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Enumeration Date | 11/06/2024
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Last Update Date | 11/06/2024
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Provider Practice Location Address
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Address Line | 225 BROADWAY STE 2130
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City | NEW YORK
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State | NY
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Zip | 10007-3733
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Country | US
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Telephone | 917-512-3899
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Fax |
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Provider Business Mailing Address
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Address Line | 20 8TH AVE APT 1A
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City | BROOKLYN
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State | NY
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Zip | 11217-3729
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Country | US
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Telephone |
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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 | 101200000X
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Taxonomy Name | Drama Therapist
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License Number | 002797
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License Number State | NY
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