MEDICARE: DR. RITA SEIDEN L.C.S.W.

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	28925	CA
2	1041C0700X	Clinical Social Worker	R030612	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	28925	OTHER	CA	LCSW
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	R030612	OTHER	NY	NYS LCSW

General Provider Information

NPI Number	:	1083613939
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RITA SEIDEN L.C.S.W.

Provider Business Mailing Address
First Line	:	13600 MARINA POINTE DR UNIT 315
Second Line	:
City	:	MARINA DEL REY
State	:	CA
Zip	:	90292-9248
Country	:	US
Telephone Number	:	718-415-8213
Fax Number	:	310-751-6439

Provider Business Practice Location Address
First Line	:	4519 ADMIRALTY WAY STE 200
Second Line	:
City	:	MARINA DEL REY
State	:	CA
Zip	:	90292
Country	:	US
Telephone Number	:	718-415-8213
Fax Number	:

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

Provider Enumeration Date	:	07/21/2005
Last Update Date	:	05/30/2018

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Directions to “ DR. RITA SEIDEN L.C.S.W.” Practice Location

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