Provider Demographics
NPI:1194943605
Name:SEITLER, JEANNE LEE (PSYD)
Entity type:Individual
Prefix:
First Name:JEANNE
Middle Name:LEE
Last Name:SEITLER
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 GARBER SQUARE
Mailing Address - Street 2:SUITE 5
Mailing Address - City:RIDGEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07450
Mailing Address - Country:US
Mailing Address - Phone:201-670-4044
Mailing Address - Fax:201-670-0063
Practice Address - Street 1:10 GARBER SQUARE
Practice Address - Street 2:SUITE 5
Practice Address - City:RIDGEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07450
Practice Address - Country:US
Practice Address - Phone:201-670-4044
Practice Address - Fax:201-670-0063
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-22
Last Update Date:2020-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS-08746-L103TC0700X
NJ35SI00421300103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1135886OtherAETNA
NJP3574836OtherOXFORD