Provider Demographics
NPI:1194746511
Name:KRIEGER, SETH T (PSYD)
Entity type:Individual
Prefix:
First Name:SETH
Middle Name:T
Last Name:KRIEGER
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26300 SEVILLE DR
Mailing Address - Street 2:APT 205
Mailing Address - City:BEACHWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44122-7594
Mailing Address - Country:US
Mailing Address - Phone:216-255-2558
Mailing Address - Fax:
Practice Address - Street 1:3591 RESERVE COMMONS DR
Practice Address - Street 2:SUITE 301
Practice Address - City:MEDINA
Practice Address - State:OH
Practice Address - Zip Code:44256-5334
Practice Address - Country:US
Practice Address - Phone:330-764-7916
Practice Address - Fax:330-723-6933
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH6189103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical