MEDICARE: SEALY MENTAL HEALTH COUNSELING SERVICE INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	3864	MA

General Provider Information

NPI Number	:	1528300902
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SEALY MENTAL HEALTH COUNSELING SERVICE INC.

Provider Business Mailing Address
First Line	:	370 MAIN ST STE 910
Second Line	:
City	:	WORCESTER
State	:	MA
Zip	:	01608-1723
Country	:	US
Telephone Number	:	508-752-5444
Fax Number	:

Provider Business Practice Location Address
First Line	:	370 MAIN ST STE 910
Second Line	:
City	:	WORCESTER
State	:	MA
Zip	:	01608-1723
Country	:	US
Telephone Number	:	508-752-5444
Fax Number	:	661-360-9453

Authorized Official
Title or Position	:	MANAGER
Name	:	DR. AUGUSTUS C SEALY
Credential	:	PH.D,LMHC
Telephone Number	:	508-752-5444

Provider Enumeration Date	:	03/23/2013
Last Update Date	:	12/21/2024

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