Provider Demographics
NPI:1568513117
Name:SEADALE, COLLEEN MARIE (LMFT)
Entity Type:Individual
Prefix:MRS
First Name:COLLEEN
Middle Name:MARIE
Last Name:SEADALE
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 BOLD MEADOW ROAD,
Mailing Address - Street 2:
Mailing Address - City:EDGARTOWN
Mailing Address - State:MA
Mailing Address - Zip Code:02539-6534
Mailing Address - Country:US
Mailing Address - Phone:774-563-9717
Mailing Address - Fax:508-627-4318
Practice Address - Street 1:10 BOLD MEADOW ROAD,
Practice Address - Street 2:
Practice Address - City:EDGARTOWN
Practice Address - State:MA
Practice Address - Zip Code:02539-6534
Practice Address - Country:US
Practice Address - Phone:774-563-9717
Practice Address - Fax:508-627-4318
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-12
Last Update Date:2010-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMT2115106H00000X
MA1366106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist