Provider Demographics
NPI:1003527623
Name:SEALY, SUSAN FERRIS (CADC)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:FERRIS
Last Name:SEALY
Suffix:
Gender:F
Credentials:CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:458 WISCASSET RD
Mailing Address - Street 2:
Mailing Address - City:BOOTHBAY
Mailing Address - State:ME
Mailing Address - Zip Code:04537-4624
Mailing Address - Country:US
Mailing Address - Phone:207-373-6942
Mailing Address - Fax:
Practice Address - Street 1:66 BARIBEAU DR
Practice Address - Street 2:
Practice Address - City:BRUNSWICK
Practice Address - State:ME
Practice Address - Zip Code:04011-3230
Practice Address - Country:US
Practice Address - Phone:207-373-6942
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-06
Last Update Date:2022-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECAC8163101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)