Provider Demographics
NPI:1265518120
Name:SEBOR, STEPHEN ALLAN (LCSW)
Entity type:Individual
Prefix:MR
First Name:STEPHEN
Middle Name:ALLAN
Last Name:SEBOR
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:760 CHURCH STREET
Mailing Address - Street 2:
Mailing Address - City:BOHEMIA
Mailing Address - State:NY
Mailing Address - Zip Code:11716-5002
Mailing Address - Country:US
Mailing Address - Phone:631-589-5465
Mailing Address - Fax:
Practice Address - Street 1:220 MAIN STREET
Practice Address - Street 2:
Practice Address - City:CENTER MORICHES
Practice Address - State:NY
Practice Address - Zip Code:11934-3504
Practice Address - Country:US
Practice Address - Phone:631-874-2700
Practice Address - Fax:631-874-3786
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0726621041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYNF7131Medicare ID - Type Unspecified