MEDICARE: JESSICA S SEIDEL

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	076142-1	NY

General Provider Information

NPI Number	:	1750808515
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSICA S SEIDEL

Provider Business Mailing Address
First Line	:	15 S ECKAR ST
Second Line	:
City	:	IRVINGTON
State	:	NY
Zip	:	10533-1606
Country	:	US
Telephone Number	:	201-892-9692
Fax Number	:

Provider Business Practice Location Address
First Line	:	547 SAW MILL RIVER RD STE 1A
Second Line	:
City	:	ARDSLEY
State	:	NY
Zip	:	10502-2154
Country	:	US
Telephone Number	:	201-892-9692
Fax Number	:

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

Provider Enumeration Date	:	08/23/2017
Last Update Date	:	08/23/2017

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Directions to “ JESSICA S SEIDEL ” Practice Location

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