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449 Bontona Ave Fort Lauderdale FL 33301-2419 | |
| (954) 742-8400 | |
| (954) 742-0918 |
| Full Name | |
|---|---|
| Speciality | Psychologist |
| Location | 449 Bontona Ave, Fort Lauderdale, Florida |
| Authorized Official Name and Position | Carol Seidman (PRESIDENT) |
| Authorized Official Contact | 9547428400 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
449 Bontona Ave Fort Lauderdale FL 33301-2419 Ph: (954) 742-8400 | 449 Bontona Ave Fort Lauderdale FL 33301-2419 Ph: (954) 742-8400 |
| NPI Number | 1275627960 |
|---|---|
| Provider Enumeration Date | 10/03/2006 |
| Last Update Date | 04/18/2024 |
| Certification Date | 04/18/2024 |
| Medicare PECOS PAC ID | 8426117680 |
|---|---|
| Medicare Enrollment ID | O20081104000154 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1275627960 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC0700X | Psychologist - Clinical | (* (Not Available)) | Primary |
| Provider Name | Alyse M Gilbert |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1235314287 PECOS PAC ID: 7214013523 Enrollment ID: I20080327000226 |
| Provider Name | Carol A Seidman |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1174616841 PECOS PAC ID: 7315007374 Enrollment ID: I20101230000439 |
| Provider Name | Traci J Seidman |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1740376672 PECOS PAC ID: 4981871134 Enrollment ID: I20120111000828 |
| Provider Name | Scott T Leydig |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1770954604 PECOS PAC ID: 3375847726 Enrollment ID: I20160205001187 |
| Provider Name | Benjamin T Bachus |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1568912897 PECOS PAC ID: 4688941818 Enrollment ID: I20170518002078 |
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