Basic Information
Provider Information
NPI: 1003003930
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: BEHAN
FirstName: SEAN
MiddleName: M
NamePrefix:  
NameSuffix:  
Credential: MA, LPC, NCC
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 630 FITZWATERTOWN RD
Address2:  
City: WILLOW GROVE
State: PA
PostalCode: 190901927
CountryCode: US
TelephoneNumber: 2156584550
FaxNumber: 2156584551
Practice Location
Address1: 630 FITZWATERTOWN RD
Address2:  
City: WILLOW GROVE
State: PA
PostalCode: 190901927
CountryCode: US
TelephoneNumber: 2156584550
FaxNumber: 2156584551
Other Information
ProviderEnumerationDate: 09/25/2007
LastUpdateDate: 02/01/2019
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
101YP2500XPC008035PAY Behavioral Health & Social Service ProvidersCounselorProfessional
174400000X  N Other Service ProvidersSpecialist 

ID Information
IDTypeStateIssuerDescription
PC00803501PASTATE LICENSEOTHER


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