Provider Demographics
NPI:1417510553
Name:STULTZ, SETH ANDREW I
Entity Type:Individual
Prefix:
First Name:SETH
Middle Name:ANDREW
Last Name:STULTZ
Suffix:I
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 1:23 BRANCH ST
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:MA
Mailing Address - Zip Code:02169-7561
Mailing Address - Country:US
Mailing Address - Phone:347-972-3006
Mailing Address - Fax:
Practice Address - Street 1:23 BRANCH ST
Practice Address - Street 2:
Practice Address - City:QUINCY
Practice Address - State:MA
Practice Address - Zip Code:02169-7561
Practice Address - Country:US
Practice Address - Phone:347-972-3006
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-15
Last Update Date:2019-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health