Provider Demographics
NPI:1467778852
Name:SEISAY, MABEL B
Entity Type:Individual
Prefix:
First Name:MABEL
Middle Name:B
Last Name:SEISAY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7121 MAGNOLIA AVE STE J
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92504-3805
Mailing Address - Country:US
Mailing Address - Phone:951-518-3518
Mailing Address - Fax:
Practice Address - Street 1:7121 MAGNOLIA AVE STE J
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92504-3805
Practice Address - Country:US
Practice Address - Phone:951-763-8688
Practice Address - Fax:951-465-7565
Is Sole Proprietor?:No
Enumeration Date:2010-04-11
Last Update Date:2020-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CA106867106H00000X
CAIMF70444106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program