Provider Demographics
NPI:1679059992
Name:DWYER, SEAL SOPHIE (LMFT)
Entity Type:Individual
Prefix:
First Name:SEAL
Middle Name:SOPHIE
Last Name:DWYER
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 1:14 7TH AVE N
Mailing Address - Street 2:
Mailing Address - City:SAINT CLOUD
Mailing Address - State:MN
Mailing Address - Zip Code:56303-4753
Mailing Address - Country:US
Mailing Address - Phone:320-296-2530
Mailing Address - Fax:
Practice Address - Street 1:14 7TH AVE N
Practice Address - Street 2:
Practice Address - City:SAINT CLOUD
Practice Address - State:MN
Practice Address - Zip Code:56303-4753
Practice Address - Country:US
Practice Address - Phone:320-296-2530
Practice Address - Fax:320-323-4387
Is Sole Proprietor?:No
Enumeration Date:2018-07-19
Last Update Date:2021-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3481106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
1083587579OtherGROUP NPI