Healthcare Provider Details

I. General information

NPI: 1376744375
Provider Name (Legal Business Name): STEPHEN P SELIGMAN D.M.H.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: STEPHEN P SELIGMAN CLINICAL PSYCHOLOGY

II. Dates (important events)

Enumeration Date: 05/29/2007
Last Update Date: 10/07/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3667 SACRAMENTO ST
SAN FRANCISCO CA
94118-1709
US

IV. Provider business mailing address

3667 SACRAMENTO ST
SAN FRANCISCO CA
94118-1709
US

V. Phone/Fax

Practice location:
  • Phone: 415-567-6369
  • Fax:
Mailing address:
  • Phone: 415-567-6369
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code102L00000X
TaxonomyPsychoanalyst
License Number83510
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPSY 8351
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: