Provider Demographics
NPI:1053735456
Name:SEIDEN, EVAN (LCSW)
Entity type:Individual
Prefix:
First Name:EVAN
Middle Name:
Last Name:SEIDEN
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1600 7TH AVE
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:NY
Mailing Address - Zip Code:12180-3410
Mailing Address - Country:US
Mailing Address - Phone:518-270-2800
Mailing Address - Fax:518-270-2848
Practice Address - Street 1:77 TROY RD STE 2
Practice Address - Street 2:
Practice Address - City:EAST GREENBUSH
Practice Address - State:NY
Practice Address - Zip Code:12061-1330
Practice Address - Country:US
Practice Address - Phone:518-596-9488
Practice Address - Fax:518-478-8015
Is Sole Proprietor?:No
Enumeration Date:2014-02-06
Last Update Date:2020-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY082736-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0921912OtherLCSW R