Provider Demographics
NPI:1144775958
Name:MACAULEY, SEAN (LMFT)
Entity Type:Individual
Prefix:
First Name:SEAN
Middle Name:
Last Name:MACAULEY
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:224 ROCK LANDING RD
Mailing Address - Street 2:
Mailing Address - City:HADDAM NECK
Mailing Address - State:CT
Mailing Address - Zip Code:06424-3011
Mailing Address - Country:US
Mailing Address - Phone:860-334-6135
Mailing Address - Fax:
Practice Address - Street 1:99 CITIZENS DR
Practice Address - Street 2:
Practice Address - City:GLASTONBURY
Practice Address - State:CT
Practice Address - Zip Code:06033-1262
Practice Address - Country:US
Practice Address - Phone:860-334-6135
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-22
Last Update Date:2016-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT1614106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist