Provider Demographics
NPI:1164659967
Name:TOLLIVER, SEAN (LCSW)
Entity Type:Individual
Prefix:
First Name:SEAN
Middle Name:
Last Name:TOLLIVER
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:SEAN
Other - Middle Name:
Other - Last Name:TOLLIVER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RCSW
Mailing Address - Street 1:165 N VILLAGE AVE
Mailing Address - Street 2:SUITE 4A
Mailing Address - City:ROCKVILLE CENTRE
Mailing Address - State:NY
Mailing Address - Zip Code:11570-3761
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:165 N VILLAGE AVE
Practice Address - Street 2:SUITE 4A
Practice Address - City:ROCKVILLE CENTRE
Practice Address - State:NY
Practice Address - Zip Code:11570-3761
Practice Address - Country:US
Practice Address - Phone:516-536-4008
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-18
Last Update Date:2009-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR035509-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical