Provider Demographics
NPI:1922434174
Name:SEIDENBERG, DAVID (LCSW)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:SEIDENBERG
Suffix:
Gender:M
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:PO BOX 1536
Mailing Address - Street 2:
Mailing Address - City:MORGANTON
Mailing Address - State:NC
Mailing Address - Zip Code:28680-1536
Mailing Address - Country:US
Mailing Address - Phone:828-437-3000
Mailing Address - Fax:828-437-4999
Practice Address - Street 1:361 N MAIN ST
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:NC
Practice Address - Zip Code:28752-3729
Practice Address - Country:US
Practice Address - Phone:828-652-5444
Practice Address - Fax:828-652-5837
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-19
Last Update Date:2014-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0089291041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCC008929OtherLICENSE