Provider Demographics
NPI:1669841532
Name:SEALES, LYDIA (RN)
Entity Type:Individual
Prefix:
First Name:LYDIA
Middle Name:
Last Name:SEALES
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:LYDIA
Other - Middle Name:
Other - Last Name:SEALES-FULLER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RN
Mailing Address - Street 1:322 PLEASANT AVE APT 6C
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10035-5067
Mailing Address - Country:US
Mailing Address - Phone:347-647-2949
Mailing Address - Fax:
Practice Address - Street 1:322 PLEASANT AVE APT 6C
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10035-5067
Practice Address - Country:US
Practice Address - Phone:347-647-2949
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-21
Last Update Date:2015-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY6609461104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker