Provider Demographics
NPI:1689178634
Name:VERNER, SEAN EDWARD (CAS-1)
Entity Type:Individual
Prefix:
First Name:SEAN
Middle Name:EDWARD
Last Name:VERNER
Suffix:
Gender:M
Credentials:CAS-1
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2625 UNIVERSITY AVE
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92104-2809
Mailing Address - Country:US
Mailing Address - Phone:619-818-1738
Mailing Address - Fax:
Practice Address - Street 1:2980 CEDAR ST
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92102-1599
Practice Address - Country:US
Practice Address - Phone:619-260-1605
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-22
Last Update Date:2018-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACI07100317101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)