Provider Demographics
NPI:1417410028
Name:SEAVER, MICHAEL ANTHONY (LADC)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:ANTHONY
Last Name:SEAVER
Suffix:
Gender:M
Credentials:LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:279 MOUNT PARNASSUS RD
Mailing Address - Street 2:
Mailing Address - City:EAST HADDAM
Mailing Address - State:CT
Mailing Address - Zip Code:06423-1527
Mailing Address - Country:US
Mailing Address - Phone:860-287-2247
Mailing Address - Fax:
Practice Address - Street 1:279 MOUNT PARNASSUS RD
Practice Address - Street 2:
Practice Address - City:EAST HADDAM
Practice Address - State:CT
Practice Address - Zip Code:06423-1527
Practice Address - Country:US
Practice Address - Phone:860-287-2247
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-10
Last Update Date:2019-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT1233101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)