Provider Demographics
NPI:1649318916
Name:SEIDEL, ROBERT M (MSSW, LCSW)
Entity type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:M
Last Name:SEIDEL
Suffix:
Gender:M
Credentials:MSSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:508 DEEP EDDY AVE
Mailing Address - Street 2:SUITE 3D
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78703-4555
Mailing Address - Country:US
Mailing Address - Phone:512-473-8293
Mailing Address - Fax:512-469-0889
Practice Address - Street 1:508 DEEP EDDY AVE
Practice Address - Street 2:SUITE 3D
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78703-4555
Practice Address - Country:US
Practice Address - Phone:512-473-8293
Practice Address - Fax:512-469-0889
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX036791041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical