Provider Demographics
NPI:1740376672
Name:SEIDMAN, TRACI (PHD)
Entity type:Individual
Prefix:
First Name:TRACI
Middle Name:
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 1:7800 W. OAKLAND PARK BLVD.
Mailing Address - Street 2:SUITE 102
Mailing Address - City:SUNRISE
Mailing Address - State:FL
Mailing Address - Zip Code:33351-6742
Mailing Address - Country:US
Mailing Address - Phone:954-742-8400
Mailing Address - Fax:954-742-0918
Practice Address - Street 1:7800 W. OAKLAND PARK BLVD.
Practice Address - Street 2:SUITE 102
Practice Address - City:SUNRISE
Practice Address - State:FL
Practice Address - Zip Code:33351-6742
Practice Address - Country:US
Practice Address - Phone:954-742-8400
Practice Address - Fax:954-742-0918
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY4567103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL73840ZMedicare ID - Type UnspecifiedPROVIDER NUMBER