Provider Demographics
NPI:1508124538
Name:SEIDMAN, LARRY NEAL (PHD)
Entity Type:Individual
Prefix:DR
First Name:LARRY
Middle Name:NEAL
Last Name:SEIDMAN
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 1:1030 N. KINGS HIGHWAY
Mailing Address - Street 2:SUITE 325
Mailing Address - City:CHERRY
Mailing Address - State:NJ
Mailing Address - Zip Code:08034
Mailing Address - Country:US
Mailing Address - Phone:856-667-4010
Mailing Address - Fax:856-667-7055
Practice Address - Street 1:1030 KINGS HWY N
Practice Address - Street 2:SUITE 325
Practice Address - City:CHERRY HILL
Practice Address - State:NJ
Practice Address - Zip Code:08034-1907
Practice Address - Country:US
Practice Address - Phone:856-667-4010
Practice Address - Fax:856-667-7055
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-27
Last Update Date:2024-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ35S1000279000101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ538189000OtherMAGELLAN