Provider Demographics
NPI:1962218040
Name:MITTLEMAN, SETH (CPSS)
Entity type:Individual
Prefix:
First Name:SETH
Middle Name:
Last Name:MITTLEMAN
Suffix:
Gender:M
Credentials:CPSS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 50597
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29250-0597
Mailing Address - Country:US
Mailing Address - Phone:803-726-9400
Mailing Address - Fax:
Practice Address - Street 1:1068 S LAKE DR
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:SC
Practice Address - Zip Code:29073-3720
Practice Address - Country:US
Practice Address - Phone:803-726-9493
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-04
Last Update Date:2024-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist