Provider Demographics
NPI:1003970054
Name:SEIBERT, SEAN WILLIAM (PHD)
Entity Type:Individual
Prefix:
First Name:SEAN
Middle Name:WILLIAM
Last Name:SEIBERT
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:515 PINE STREET
Mailing Address - Street 2:
Mailing Address - City:JAMESTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:14701-5315
Mailing Address - Country:US
Mailing Address - Phone:716-664-7501
Mailing Address - Fax:716-664-5186
Practice Address - Street 1:515 PINE STREET
Practice Address - Street 2:
Practice Address - City:JAMESTOWN
Practice Address - State:NY
Practice Address - Zip Code:14701-5315
Practice Address - Country:US
Practice Address - Phone:716-664-7501
Practice Address - Fax:716-664-5186
Is Sole Proprietor?:No
Enumeration Date:2006-12-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0105132103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
6893537002OtherVALUE OPTIONS
NY01243856Medicaid
00020913301OtherUNIVERA
324244OtherMHN
NY000511085001OtherBCBS
11305OtherFIDELIS
6107105OtherINDEPENDENT HEALTH
PA725284OtherBCBS
6107105OtherINDEPENDENT HEALTH
R55969Medicare UPIN