Provider Demographics
NPI:1174731921
Name:SEIDEL, MARY BRESEE (LCPC)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:BRESEE
Last Name:SEIDEL
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7402 YORK RD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:TOWSON
Mailing Address - State:MD
Mailing Address - Zip Code:21204-7532
Mailing Address - Country:US
Mailing Address - Phone:410-254-1458
Mailing Address - Fax:410-823-7405
Practice Address - Street 1:7402 YORK RD
Practice Address - Street 2:SUITE 201
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21204-7532
Practice Address - Country:US
Practice Address - Phone:410-254-1458
Practice Address - Fax:410-823-7405
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLCO714101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDM499OtherCAREFIRST
MD64529301OtherCAREFIRST BLUE CROSS