Provider Demographics
NPI:1639819584
Name:RECKWERDT, SEAN (LCAT)
Entity Type:Individual
Prefix:
First Name:SEAN
Middle Name:
Last Name:RECKWERDT
Suffix:
Gender:M
Credentials:LCAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:767 BERGEN ST PH 4A
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11238-4491
Mailing Address - Country:US
Mailing Address - Phone:608-772-1227
Mailing Address - Fax:
Practice Address - Street 1:767 BERGEN ST PH 4A
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11238-4491
Practice Address - Country:US
Practice Address - Phone:608-772-1227
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-30
Last Update Date:2022-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002509221700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes221700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersArt Therapist