Provider Demographics
NPI:1295391027
Name:MEDINA-SEABRIGHT, AMARANTA (LCAT, ATR-BC)
Entity type:Individual
Prefix:MS
First Name:AMARANTA
Middle Name:
Last Name:MEDINA-SEABRIGHT
Suffix:
Gender:F
Credentials:LCAT, ATR-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:195 WILLOUGHBY AVE APT 1604
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11205-3831
Mailing Address - Country:US
Mailing Address - Phone:415-302-3113
Mailing Address - Fax:
Practice Address - Street 1:756 LEONARD ST APT 1R
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11222-7001
Practice Address - Country:US
Practice Address - Phone:415-302-3113
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-16
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002053221700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes221700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersArt Therapist