Provider Demographics
NPI:1922169390
Name:SEQUEIRA, HAROLD (LCSW,MA)
Entity Type:Individual
Prefix:
First Name:HAROLD
Middle Name:
Last Name:SEQUEIRA
Suffix:
Gender:M
Credentials:LCSW,MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 BROOKVALE LN
Mailing Address - Street 2:
Mailing Address - City:LAKE GROVE
Mailing Address - State:NY
Mailing Address - Zip Code:11755-2708
Mailing Address - Country:US
Mailing Address - Phone:631-285-6777
Mailing Address - Fax:
Practice Address - Street 1:998 CROOKED HILL RD
Practice Address - Street 2:
Practice Address - City:BRENTWOOD
Practice Address - State:NY
Practice Address - Zip Code:11717-1043
Practice Address - Country:US
Practice Address - Phone:631-306-5764
Practice Address - Fax:631-306-5885
Is Sole Proprietor?:No
Enumeration Date:2006-12-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR051591-1101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)