Healthcare Provider Details

I. General information

NPI: 1801879747
Provider Name (Legal Business Name): DAVID N SEIDMAN ED.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 11/23/2005
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8302 OLD YORK RD
ELKINS PARK PA
19027-1522
US

IV. Provider business mailing address

588 HIDDEN LAIR DR
BLUE BELL PA
19422-1368
US

V. Phone/Fax

Practice location:
  • Phone: 215-572-6517
  • Fax: 215-576-7816
Mailing address:
  • Phone: 215-699-3605
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPS003335L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: