Healthcare Provider Details

I. General information

NPI: 1174848212
Provider Name (Legal Business Name): JESSICA LYNN SEIDENBERG PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/01/2010
Last Update Date: 04/01/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

426 FRANKLIN ST
SCHENECTADY NY
12305-2040
US

IV. Provider business mailing address

426 FRANKLIN ST
SCHENECTADY NY
12305-2040
US

V. Phone/Fax

Practice location:
  • Phone: 518-374-3403
  • Fax: 518-374-3482
Mailing address:
  • Phone: 518-374-3403
  • Fax: 518-374-3482

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number012178-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: