Provider Demographics
NPI:1720686819
Name:SEIDMAN, DENISE A (LMFT)
Entity Type:Individual
Prefix:MS
First Name:DENISE
Middle Name:A
Last Name:SEIDMAN
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:MS
Other - First Name:DENISE
Other - Middle Name:A
Other - Last Name:SEIDMAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMFT
Mailing Address - Street 1:1009 SUNDAY DR
Mailing Address - Street 2:
Mailing Address - City:NIPOMO
Mailing Address - State:CA
Mailing Address - Zip Code:93444-5747
Mailing Address - Country:US
Mailing Address - Phone:805-264-7228
Mailing Address - Fax:
Practice Address - Street 1:1009 SUNDAY DR
Practice Address - Street 2:
Practice Address - City:NIPOMO
Practice Address - State:CA
Practice Address - Zip Code:93444-5747
Practice Address - Country:US
Practice Address - Phone:805-264-7228
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-12
Last Update Date:2020-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC37331106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist