Provider Demographics
NPI:1376744375
Name:SELIGMAN, STEPHEN P (DMH)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:P
Last Name:SELIGMAN
Suffix:
Gender:M
Credentials:DMH
Other - Prefix:
Other - First Name:STEPHEN
Other - Middle Name:P
Other - Last Name:SELIGMAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CLINICAL PSYCHOLOGY
Mailing Address - Street 1:3667 SACRAMENTO ST
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94118-1709
Mailing Address - Country:US
Mailing Address - Phone:415-567-6369
Mailing Address - Fax:
Practice Address - Street 1:3667 SACRAMENTO ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94118-1709
Practice Address - Country:US
Practice Address - Phone:415-567-6369
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-29
Last Update Date:2011-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA83510102L00000X
CAPSY 8351103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No102L00000XBehavioral Health & Social Service ProvidersPsychoanalyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAOOPL83510Medicare ID - Type Unspecified