Provider Demographics
NPI:1255037578
Name:SISSON, SEAN
Entity type:Individual
Prefix:
First Name:SEAN
Middle Name:
Last Name:SISSON
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 1:65 OVERLAND AVE
Mailing Address - Street 2:
Mailing Address - City:CRANSTON
Mailing Address - State:RI
Mailing Address - Zip Code:02910-2517
Mailing Address - Country:US
Mailing Address - Phone:401-585-3227
Mailing Address - Fax:
Practice Address - Street 1:65 OVERLAND AVE
Practice Address - Street 2:
Practice Address - City:CRANSTON
Practice Address - State:RI
Practice Address - Zip Code:02910-2517
Practice Address - Country:US
Practice Address - Phone:401-585-3227
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-07
Last Update Date:2023-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician