MEDICARE: MR. ROBERT M SEIDEL M.S.S.W., LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	03679	TX

General Provider Information

NPI Number	:	1649318916
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ROBERT M SEIDEL M.S.S.W., LCSW

Provider Business Mailing Address
First Line	:	508 DEEP EDDY AVE
Second Line	:	SUITE 3D
City	:	AUSTIN
State	:	TX
Zip	:	78703-4555
Country	:	US
Telephone Number	:	512-473-8293
Fax Number	:	512-469-0889

Provider Business Practice Location Address
First Line	:	508 DEEP EDDY AVE
Second Line	:	SUITE 3D
City	:	AUSTIN
State	:	TX
Zip	:	78703-4555
Country	:	US
Telephone Number	:	512-473-8293
Fax Number	:	512-469-0889

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/01/2007
Last Update Date	:	07/08/2007

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