Provider Demographics
NPI:1861145500
Name:MCFADDEN, SEAN MICHAEL
Entity type:Individual
Prefix:
First Name:SEAN
Middle Name:MICHAEL
Last Name:MCFADDEN
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 1:18515 GREVILLEA AVE
Mailing Address - Street 2:
Mailing Address - City:REDONDO BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90278-4629
Mailing Address - Country:US
Mailing Address - Phone:310-714-0425
Mailing Address - Fax:
Practice Address - Street 1:18515 GREVILLEA AVE
Practice Address - Street 2:
Practice Address - City:REDONDO BEACH
Practice Address - State:CA
Practice Address - Zip Code:90278-4629
Practice Address - Country:US
Practice Address - Phone:310-714-0425
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-02
Last Update Date:2022-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician