Provider Demographics
NPI:1285040600
Name:BEDFORD, SEAN
Entity Type:Individual
Prefix:
First Name:SEAN
Middle Name:
Last Name:BEDFORD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 SCARLETT CT
Mailing Address - Street 2:APT 16
Mailing Address - City:NEW CITY
Mailing Address - State:NY
Mailing Address - Zip Code:10956-5030
Mailing Address - Country:US
Mailing Address - Phone:845-708-5579
Mailing Address - Fax:
Practice Address - Street 1:7 SCARLETT CT
Practice Address - Street 2:APT 16
Practice Address - City:NEW CITY
Practice Address - State:NY
Practice Address - Zip Code:10956-5030
Practice Address - Country:US
Practice Address - Phone:845-708-5579
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-07
Last Update Date:2014-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children