Provider Demographics
NPI:1578378824
Name:MIGGINS, SEAN S
Entity type:Individual
Prefix:
First Name:SEAN
Middle Name:S
Last Name:MIGGINS
Suffix:
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 1:6518 ELLICOTT STREET RD APT B
Mailing Address - Street 2:
Mailing Address - City:PAVILION
Mailing Address - State:NY
Mailing Address - Zip Code:14525-9625
Mailing Address - Country:US
Mailing Address - Phone:917-992-1549
Mailing Address - Fax:
Practice Address - Street 1:317 WEST AVE
Practice Address - Street 2:
Practice Address - City:ALBION
Practice Address - State:NY
Practice Address - Zip Code:14411-1522
Practice Address - Country:US
Practice Address - Phone:917-992-1549
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-12
Last Update Date:2025-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY126576104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker