Provider Demographics
NPI:1518304450
Name:LARE, SEAN (LCSW-C)
Entity Type:Individual
Prefix:
First Name:SEAN
Middle Name:
Last Name:LARE
Suffix:
Gender:M
Credentials:LCSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5436 WILD LILAC
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21045-2431
Mailing Address - Country:US
Mailing Address - Phone:410-689-9074
Mailing Address - Fax:
Practice Address - Street 1:6851 OAK HALL LN
Practice Address - Street 2:SUITE 118
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21045-5846
Practice Address - Country:US
Practice Address - Phone:410-689-9074
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-02
Last Update Date:2016-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD177441041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical