Individual provider Active NPI

Harold Sequeira, LCSW-R

  • Addiction (Substance Use Disorder) Counselor
  • Smithtown, NY
National Provider Identifier
1922169390
Registry record updated Mar 12, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X
License
R051591-1 Issued in NY
Practice address
11 Route 111
Smithtown, NY 11787-3754
Phone
(631) 920-8310
NPI assigned
Dec 12, 2006
Last updated
Mar 12, 2025By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 12, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Addiction (Substance Use Disorder) Counselor 101YA0400X R051591-1 NY Primary

Addresses

Primary practice location

11 Route 111
Smithtown, NY 11787-3754

Mailing address

11 Route 111
Smithtown, NY 11787-3754
Phone (631) 920-8310

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20070712000331 NY Practitioner - Clinical Social Worker 6406956945 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 1994
Medicare assignment
May accept Medicare assignment
Telehealth
Offers telehealth services
Group practices
Welllife Network IncGroup PAC ID 0749179570, 17 clinicians

Practice addresses (Care Compare)

11 Route 111
Smithtown, NY 11787-3754
Phone (631) 920-8000

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
R051591-1NYMDAddiction (Substance Use Disorder) Counselor

Practice roles

OrganizationSpecialtyStatusNew patients
Welllife Network Inc CurrentSince Jul 29, 2023 Accepting new patients
Welllife Network Inc., CurrentSince Jul 29, 2023 Accepting new patients

Locations

14202 20th Ave
Fl 3
Flushing, NY 11351
Phone (718) 559-0516

800 Northern Blvd
Great Neck, NY 11021
Phone (516) 829-8450

11 Route 111
Smithtown, NY 11787
Phone (631) 656-9550

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1165881600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1741737600000",
    "number": "1922169390",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11 ROUTE 111",
            "city": "SMITHTOWN",
            "state": "NY",
            "postal_code": "117873754",
            "telephone_number": "631-920-8310"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11 ROUTE 111",
            "city": "SMITHTOWN",
            "state": "NY",
            "postal_code": "117873754",
            "telephone_number": "631-920-8310"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SEQUEIRA",
        "first_name": "HAROLD",
        "credential": "LCSW-R",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-12-12",
        "last_updated": "2025-03-12",
        "certification_date": "2025-03-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "NY",
            "license": "R051591-1",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Smithtown, NY

Sources for this page

Verify at the official NPI Registry.