Provider Demographics
NPI:1003504028
Name:SEIDMAN, JERI NICOLE (LMHC)
Entity Type:Individual
Prefix:
First Name:JERI
Middle Name:NICOLE
Last Name:SEIDMAN
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5301 N FEDERAL HIGHWAY
Mailing Address - Street 2:SUITE 380 BOX 416
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33487
Mailing Address - Country:US
Mailing Address - Phone:561-430-1920
Mailing Address - Fax:
Practice Address - Street 1:5301 N FEDERAL HIGHWAY
Practice Address - Street 2:SUITE 380 OFFICE #18
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33487
Practice Address - Country:US
Practice Address - Phone:561-430-1920
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-27
Last Update Date:2023-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH19049101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health