Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103G00000X | Clinical Psychologist | MA-10271 | MA |
Y | 103TC0700X | Clinical Psychologist | MA-10271 | MA |
N | 103G00000X | Clinical Psychologist | TPS030364 | PR |
N | 103TC0700X | Clinical Psychologist | TPS030364 | PR |
N | 103G00000X | Clinical Psychologist | TPS030364 | PA |
N | 103TC0700X | Clinical Psychologist | TPS030364 | PA |
N | 103TC2200X | Clinical Child & Adolescent Psychologist | TPS030364 | PA |
N | 103TS0200X | School Psychologist | TPS030364 | PA |
NPI | 1093263295 |
---|---|
Provider Name | Dr. Ann Marie Melissa Seidel |
First Address | Lexington, MA 02420-4641 |
Second Address | Newtown, PA 18940-3329 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/09/2016 |
Last Update Date | 13/04/2021 |