Provider Demographics
NPI:1528153319
Name:SEIDERMAN, SIMONA ALLISON (LMSW, DCSW, BCD)
Entity type:Individual
Prefix:MRS
First Name:SIMONA
Middle Name:ALLISON
Last Name:SEIDERMAN
Suffix:
Gender:F
Credentials:LMSW, DCSW, BCD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5600 W MAPLE RD
Mailing Address - Street 2:SUITE C - 311
Mailing Address - City:WEST BLOOMFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48322-3704
Mailing Address - Country:US
Mailing Address - Phone:248-737-4750
Mailing Address - Fax:
Practice Address - Street 1:5600 W MAPLE RD
Practice Address - Street 2:SUITE C - 311
Practice Address - City:WEST BLOOMFIELD
Practice Address - State:MI
Practice Address - Zip Code:48322-3704
Practice Address - Country:US
Practice Address - Phone:248-737-4750
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010170531041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical