Provider Demographics
NPI:1023131091
Name:SEIDE, JANET H (PHD)
Entity type:Individual
Prefix:
First Name:JANET
Middle Name:H
Last Name:SEIDE
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 1:35 BEDFORD ST
Mailing Address - Street 2:LEXINGTON
Mailing Address - City:LEXINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:02420-4320
Mailing Address - Country:US
Mailing Address - Phone:781-862-6816
Mailing Address - Fax:
Practice Address - Street 1:35 BEDFORD ST
Practice Address - Street 2:LEXINGTON
Practice Address - City:LEXINGTON
Practice Address - State:MA
Practice Address - Zip Code:02420-4320
Practice Address - Country:US
Practice Address - Phone:781-862-6816
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3526103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAW03597Medicare ID - Type Unspecified