Provider Demographics
NPI:1760369300
Name:EMERALDBLUE LLC
Entity type:Organization
Organization Name:EMERALDBLUE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JACLYN
Authorized Official - Middle Name:SUZANNE
Authorized Official - Last Name:SEALY
Authorized Official - Suffix:
Authorized Official - Credentials:PMHNP
Authorized Official - Phone:303-909-8358
Mailing Address - Street 1:230 EMERALD ST
Mailing Address - Street 2:
Mailing Address - City:BROOMFIELD
Mailing Address - State:CO
Mailing Address - Zip Code:80020-2328
Mailing Address - Country:US
Mailing Address - Phone:303-909-8358
Mailing Address - Fax:
Practice Address - Street 1:230 EMERALD ST
Practice Address - Street 2:
Practice Address - City:BROOMFIELD
Practice Address - State:CO
Practice Address - Zip Code:80020-2328
Practice Address - Country:US
Practice Address - Phone:303-909-8358
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-08-18
Last Update Date:2025-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty