Provider Demographics
NPI:1114131323
Name:RIGBERG, SETH (PHD)
Entity Type:Individual
Prefix:
First Name:SETH
Middle Name:
Last Name:RIGBERG
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:877 MADISON AVE
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12208-3321
Mailing Address - Country:US
Mailing Address - Phone:518-482-8856
Mailing Address - Fax:518-489-5839
Practice Address - Street 1:877 MADISON AVE
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12208-3321
Practice Address - Country:US
Practice Address - Phone:518-482-8856
Practice Address - Fax:518-489-5839
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-09
Last Update Date:2016-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012129103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
11718995OtherCAQH