Provider Demographics
NPI:1508028275
Name:FORTUNE, SEANA TODD (PCC LSW LCDCIII)
Entity Type:Individual
Prefix:MRS
First Name:SEANA
Middle Name:TODD
Last Name:FORTUNE
Suffix:
Gender:F
Credentials:PCC LSW LCDCIII
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:152 NORTH BROADWAY AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:NEW PHILADELPHIA
Mailing Address - State:OH
Mailing Address - Zip Code:44663-2665
Mailing Address - Country:US
Mailing Address - Phone:330-364-9360
Mailing Address - Fax:
Practice Address - Street 1:152 N BROADWAY ST
Practice Address - Street 2:SUITE 200
Practice Address - City:NEW PHILADELPHIA
Practice Address - State:OH
Practice Address - Zip Code:44663-2665
Practice Address - Country:US
Practice Address - Phone:330-364-9360
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-25
Last Update Date:2008-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH001266101YA0400X
OHE0008398101YM0800X
OHS19914104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No104100000XBehavioral Health & Social Service ProvidersSocial Worker