Provider Demographics
NPI:1144083957
Name:SEIDEL, EMILY (PSYD)
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:
Last Name:SEIDEL
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5835 COLLEGE AVE STE B
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94618-1653
Mailing Address - Country:US
Mailing Address - Phone:510-658-7550
Mailing Address - Fax:
Practice Address - Street 1:5835 COLLEGE AVE STE B
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94618-1653
Practice Address - Country:US
Practice Address - Phone:510-658-7550
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-05
Last Update Date:2024-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY19153103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty