Provider Demographics
NPI:1265101695
Name:SEYOUM, DESET TILAHUN
Entity type:Individual
Prefix:
First Name:DESET
Middle Name:TILAHUN
Last Name:SEYOUM
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 1:7 JEANNE MARIE GDNS APT I
Mailing Address - Street 2:
Mailing Address - City:NANUET
Mailing Address - State:NY
Mailing Address - Zip Code:10954-1916
Mailing Address - Country:US
Mailing Address - Phone:845-598-1315
Mailing Address - Fax:
Practice Address - Street 1:7 JEANNE MARIE GDNS APT I
Practice Address - Street 2:
Practice Address - City:NANUET
Practice Address - State:NY
Practice Address - Zip Code:10954-1916
Practice Address - Country:US
Practice Address - Phone:845-598-1315
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-09
Last Update Date:2021-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker