Provider Demographics
NPI:1417045568
Name:SELIGMAN, MICHELE D (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:MICHELE
Middle Name:D
Last Name:SELIGMAN
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 1:45 N. BROAD ST. SUITE 206
Mailing Address - Street 2:
Mailing Address - City:RIDGEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07450-3822
Mailing Address - Country:US
Mailing Address - Phone:201-444-5347
Mailing Address - Fax:
Practice Address - Street 1:45 N. BROAD ST.
Practice Address - Street 2:SUITE 406
Practice Address - City:RIDGEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07450-3822
Practice Address - Country:US
Practice Address - Phone:201-444-5347
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-11
Last Update Date:2012-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC002033001041C0700X
NJ37F100049900106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ02354983Medicaid
NJ02354983Medicaid