Provider Demographics
NPI:1578611729
Name:SEAMAN, DIANE ODESSA (LCSW, BCD)
Entity Type:Individual
Prefix:MS
First Name:DIANE
Middle Name:ODESSA
Last Name:SEAMAN
Suffix:
Gender:F
Credentials:LCSW, BCD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 FOREST RD
Mailing Address - Street 2:
Mailing Address - City:CENTEREACH
Mailing Address - State:NY
Mailing Address - Zip Code:11720-2244
Mailing Address - Country:US
Mailing Address - Phone:631-467-2568
Mailing Address - Fax:631-467-6649
Practice Address - Street 1:1050 HALLOCK AVE
Practice Address - Street 2:SUITE #1
Practice Address - City:PORT JEFFERSON STATION
Practice Address - State:NY
Practice Address - Zip Code:11776-1214
Practice Address - Country:US
Practice Address - Phone:631-467-2554
Practice Address - Fax:631-467-6649
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-06
Last Update Date:2011-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY101YP1600X
NY027099-11041C0700X
106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYN3822-1Medicare ID - Type Unspecified