Provider Demographics
NPI:1669413308
Name:GROBMAN, SETH L (PSYD)
Entity type:Individual
Prefix:MR
First Name:SETH
Middle Name:L
Last Name:GROBMAN
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2771 EXECUTIVE PARK DRIVE
Mailing Address - Street 2:SUITE 4
Mailing Address - City:WESTON
Mailing Address - State:FL
Mailing Address - Zip Code:33331
Mailing Address - Country:US
Mailing Address - Phone:954-385-4696
Mailing Address - Fax:954-385-8385
Practice Address - Street 1:2771 EXECUTIVE PARK DRIVE
Practice Address - Street 2:SUITE 4
Practice Address - City:WESTON
Practice Address - State:FL
Practice Address - Zip Code:33331
Practice Address - Country:US
Practice Address - Phone:954-385-4696
Practice Address - Fax:954-385-8385
Is Sole Proprietor?:No
Enumeration Date:2006-06-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY0005062103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL59554AMedicare ID - Type Unspecified