Provider Demographics
NPI:1952069619
Name:STOREY, SEAN DAVID
Entity Type:Individual
Prefix:
First Name:SEAN
Middle Name:DAVID
Last Name:STOREY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7408 CISCO RD NW
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87120-3613
Mailing Address - Country:US
Mailing Address - Phone:505-720-0742
Mailing Address - Fax:
Practice Address - Street 1:7408 CISCO RD NW
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87120-3613
Practice Address - Country:US
Practice Address - Phone:505-720-0742
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-30
Last Update Date:2021-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician