Provider Demographics
NPI:1700175148
Name:SEIDMAN, JANICE (JAFFE) (PHD)
Entity type:Individual
Prefix:DR
First Name:JANICE
Middle Name:(JAFFE)
Last Name:SEIDMAN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:195 BROADWAY
Mailing Address - Street 2:LAWRENCE MIDDLE SCHOOL
Mailing Address - City:LAWRENCE
Mailing Address - State:NY
Mailing Address - Zip Code:11559
Mailing Address - Country:US
Mailing Address - Phone:516-295-7012
Mailing Address - Fax:516-295-7196
Practice Address - Street 1:195 BROADWAY
Practice Address - Street 2:LAWRENCE MIDDLE SCHOOL
Practice Address - City:LAWRENCE
Practice Address - State:NY
Practice Address - Zip Code:11559
Practice Address - Country:US
Practice Address - Phone:516-295-7012
Practice Address - Fax:516-295-7196
Is Sole Proprietor?:No
Enumeration Date:2011-04-06
Last Update Date:2011-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0131371104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker