Provider Demographics
NPI:1649253667
Name:SELIGSON, MICHAEL ROSS (PHD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:ROSS
Last Name:SELIGSON
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:DR
Other - First Name:M
Other - Middle Name:ROSS
Other - Last Name:SELIGSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:401 EAST LAS OLAS BOULEVARD
Mailing Address - Street 2:SUITE 130523
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33301-2477
Mailing Address - Country:US
Mailing Address - Phone:954-563-2800
Mailing Address - Fax:954-563-9771
Practice Address - Street 1:350 SOUTHEAST 2ND STREET
Practice Address - Street 2:SUITE 130523
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33301-1915
Practice Address - Country:US
Practice Address - Phone:954-551-7777
Practice Address - Fax:954-206-2676
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-23
Last Update Date:2020-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY0002586103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL75291AMedicare ID - Type UnspecifiedIDENTIFICATION NUMBER