Provider Demographics
NPI:1295283919
Name:SEIDEN, JENNIFER (SUDRC)
Entity type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:
Last Name:SEIDEN
Suffix:
Gender:F
Credentials:SUDRC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4011 GLENWOOD DR
Mailing Address - Street 2:
Mailing Address - City:SCOTTS VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:95066-2621
Mailing Address - Country:US
Mailing Address - Phone:831-251-2788
Mailing Address - Fax:
Practice Address - Street 1:300 HARVEY WEST BLVD
Practice Address - Street 2:
Practice Address - City:SANTA CRUZ
Practice Address - State:CA
Practice Address - Zip Code:95060-2103
Practice Address - Country:US
Practice Address - Phone:831-230-8681
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-12
Last Update Date:2023-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA171M00000XMedicaid