Provider Demographics
NPI:1114410099
Name:PLUNKETT, SEAN (MPS, LCAT)
Entity Type:Individual
Prefix:
First Name:SEAN
Middle Name:
Last Name:PLUNKETT
Suffix:
Gender:M
Credentials:MPS, LCAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1048 BEDFORD AVE APT 2R
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11205-4884
Mailing Address - Country:US
Mailing Address - Phone:347-262-7821
Mailing Address - Fax:
Practice Address - Street 1:1048 BEDFORD AVE APT 2R
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11205-4884
Practice Address - Country:US
Practice Address - Phone:347-262-7821
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-14
Last Update Date:2018-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0020911101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health