Provider Demographics
NPI:1679917173
Name:GILLIGAN, SEAN M (LCSW)
Entity Type:Individual
Prefix:
First Name:SEAN
Middle Name:M
Last Name:GILLIGAN
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 S ORANGE AVE STE 28
Mailing Address - Street 2:
Mailing Address - City:SOUTH ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07079-1931
Mailing Address - Country:US
Mailing Address - Phone:646-265-3634
Mailing Address - Fax:
Practice Address - Street 1:111 S ORANGE AVE STE 28
Practice Address - Street 2:
Practice Address - City:SOUTH ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07079-1931
Practice Address - Country:US
Practice Address - Phone:646-265-3634
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-26
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC056918001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY089271-1OtherLMSW
44SL05865100OtherNJ STATE LICENSE