Provider Demographics
NPI:1457303380
Name:SEITZ, JAY (PHD)
Entity Type:Individual
Prefix:DR
First Name:JAY
Middle Name:
Last Name:SEITZ
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 1:156 PLEASANT STREET
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:02476
Mailing Address - Country:US
Mailing Address - Phone:339-707-0528
Mailing Address - Fax:
Practice Address - Street 1:156 PLEASANT ST
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:MA
Practice Address - Zip Code:02476-8153
Practice Address - Country:US
Practice Address - Phone:339-707-0528
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-17
Last Update Date:2019-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010816103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01694077Medicaid
NY01694077Medicaid