Provider Demographics
NPI:1841408770
Name:SEIDES, MARK STEVEN (PHD PSYCHOLOGY)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:STEVEN
Last Name:SEIDES
Suffix:
Gender:M
Credentials:PHD PSYCHOLOGY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:510 E 85TH ST
Mailing Address - Street 2:8 G
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10028-7430
Mailing Address - Country:US
Mailing Address - Phone:212-772-8764
Mailing Address - Fax:
Practice Address - Street 1:510 E 85TH ST
Practice Address - Street 2:8 G
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10028-7430
Practice Address - Country:US
Practice Address - Phone:212-772-8764
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000787102L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes102L00000XBehavioral Health & Social Service ProvidersPsychoanalyst