Provider Demographics
NPI:1750169470
Name:SEWELL, BERNARD TIMOTHY III
Entity type:Individual
Prefix:MR
First Name:BERNARD
Middle Name:TIMOTHY
Last Name:SEWELL
Suffix:III
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 1:319 CAMELBACK RD APT 2
Mailing Address - Street 2:
Mailing Address - City:PLEASANT HILL
Mailing Address - State:CA
Mailing Address - Zip Code:94523-1307
Mailing Address - Country:US
Mailing Address - Phone:214-310-6174
Mailing Address - Fax:
Practice Address - Street 1:319 CAMELBACK RD APT 2
Practice Address - Street 2:
Practice Address - City:PLEASANT HILL
Practice Address - State:CA
Practice Address - Zip Code:94523-1307
Practice Address - Country:US
Practice Address - Phone:214-310-6174
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-15
Last Update Date:2023-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician