Provider Demographics
NPI:1134118201
Name:WITHINGTON, SEAN WHIPPLE (LICSW)
Entity Type:Individual
Prefix:
First Name:SEAN
Middle Name:WHIPPLE
Last Name:WITHINGTON
Suffix:
Gender:M
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 MASSASOIT ST
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02360-3407
Mailing Address - Country:US
Mailing Address - Phone:508-667-6704
Mailing Address - Fax:508-747-7470
Practice Address - Street 1:340 COURT ST
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02360-4334
Practice Address - Country:US
Practice Address - Phone:508-667-6704
Practice Address - Fax:508-747-7470
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1763101YA0400X
MA10259811041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA459396OtherTUFTS
MA70010000P07386OtherBLUE CROSS BLUE SHEILD
MAP20171Medicare ID - Type Unspecified