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General NPI Number Information
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NPI Number | 1649253667
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Entity Type | Individual
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Provider Name | MICHAEL ROSS SELIGSON PH.D.
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Gender | Male
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Dates
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Enumeration Date | 11/23/2005
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Last Update Date | 08/14/2020
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Provider Practice Location Address
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Address Line | 350 SOUTHEAST 2ND STREET SUITE 130523
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City | FORT LAUDERDALE
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State | FL
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Zip | 33301-1915
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Country | US
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Telephone | 954-551-7777
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Fax | 954-206-2676
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Provider Business Mailing Address
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Address Line | 401 EAST LAS OLAS BOULEVARD SUITE 130523
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City | FORT LAUDERDALE
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State | FL
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Zip | 33301-2477
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Country | US
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Telephone | 954-563-2800
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Fax | 954-563-9771
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PY0002586
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License Number State | FL
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