Provider Demographics
NPI:1093263295
Name:SEIDEL, ANN MARIE MELISSA (PSYD)
Entity Type:Individual
Prefix:DR
First Name:ANN MARIE
Middle Name:MELISSA
Last Name:SEIDEL
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:76 BEDFORD ST STE 34
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:02420-4641
Mailing Address - Country:US
Mailing Address - Phone:781-486-4456
Mailing Address - Fax:
Practice Address - Street 1:31 CAMBRIDGE LN
Practice Address - Street 2:
Practice Address - City:NEWTOWN
Practice Address - State:PA
Practice Address - Zip Code:18940-3329
Practice Address - Country:US
Practice Address - Phone:215-968-5151
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-15
Last Update Date:2021-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PRTPS030364103G00000X
PATPS030364103TC0700X, 103TC2200X, 103TS0200X
MAMA-10271103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
No103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool