Provider Demographics
NPI:1558981886
Name:SEVETT, PAUL (LICSW, BC-DMT)
Entity Type:Individual
Prefix:MR
First Name:PAUL
Middle Name:
Last Name:SEVETT
Suffix:
Gender:M
Credentials:LICSW, BC-DMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:757 DELAWARE AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55107-2537
Mailing Address - Country:US
Mailing Address - Phone:651-291-0942
Mailing Address - Fax:
Practice Address - Street 1:757 DELAWARE AVE
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55107-2537
Practice Address - Country:US
Practice Address - Phone:651-291-0942
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-16
Last Update Date:2020-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225600000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDance TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN12535OtherSOCIAL WORK LICENSE #12535