Provider Demographics
NPI:1720293095
Name:SEIDMAN, URSULA (PHD)
Entity Type:Individual
Prefix:MRS
First Name:URSULA
Middle Name:
Last Name:SEIDMAN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:URSULA
Other - Middle Name:
Other - Last Name:STRAUSS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:14 DRUID LANE
Mailing Address - Street 2:
Mailing Address - City:BETHEL
Mailing Address - State:CT
Mailing Address - Zip Code:06801-1487
Mailing Address - Country:US
Mailing Address - Phone:914-263-6686
Mailing Address - Fax:888-622-6162
Practice Address - Street 1:280 DOBBS FERRY ROAD
Practice Address - Street 2:
Practice Address - City:WHITE PLAINS
Practice Address - State:NY
Practice Address - Zip Code:10607-1908
Practice Address - Country:US
Practice Address - Phone:914-263-6686
Practice Address - Fax:888-622-6162
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-11
Last Update Date:2018-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011627-1103TB0200X
NY0116271103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA300083474Medicare UPIN
NY01960521Medicaid
NY101960521Medicaid
NYA300083474Medicare UPIN