Provider Demographics
NPI:1720546161
Name:SEALEY, BEVERLY CYNTHIA
Entity Type:Individual
Prefix:DR
First Name:BEVERLY
Middle Name:CYNTHIA
Last Name:SEALEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:249 GARDEN ST APT 16
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02138-1253
Mailing Address - Country:US
Mailing Address - Phone:617-491-4071
Mailing Address - Fax:
Practice Address - Street 1:249 GARDEN ST APT 16
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02138-1253
Practice Address - Country:US
Practice Address - Phone:617-491-4071
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-05
Last Update Date:2019-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1002761041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty