Provider Demographics
NPI:1063008266
Name:SEIDMAN, LINDA ELLEN (MA, LMFT)
Entity Type:Individual
Prefix:MS
First Name:LINDA
Middle Name:ELLEN
Last Name:SEIDMAN
Suffix:
Gender:F
Credentials:MA, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5535 BALBOA BLVD STE 204
Mailing Address - Street 2:
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91316-1543
Mailing Address - Country:US
Mailing Address - Phone:818-788-5778
Mailing Address - Fax:
Practice Address - Street 1:5535 BALBOA BLVD STE 204
Practice Address - Street 2:
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91316-1543
Practice Address - Country:US
Practice Address - Phone:818-788-5778
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-12
Last Update Date:2020-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC31138101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor