Provider Demographics
NPI:1083613939
Name:SEIDEN, RITA (LCSW)
Entity Type:Individual
Prefix:DR
First Name:RITA
Middle Name:
Last Name:SEIDEN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13600 MARINA POINTE DR UNIT 315
Mailing Address - Street 2:
Mailing Address - City:MARINA DEL REY
Mailing Address - State:CA
Mailing Address - Zip Code:90292-9248
Mailing Address - Country:US
Mailing Address - Phone:718-415-8213
Mailing Address - Fax:310-751-6439
Practice Address - Street 1:4519 ADMIRALTY WAY STE 200
Practice Address - Street 2:
Practice Address - City:MARINA DEL REY
Practice Address - State:CA
Practice Address - Zip Code:90292
Practice Address - Country:US
Practice Address - Phone:718-415-8213
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-21
Last Update Date:2018-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA289251041C0700X
NYR0306121041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA28925OtherLCSW
NY01518161Medicaid
NYR030612OtherNYS LCSW
NYN61531Medicare ID - Type Unspecified