Basic Information
| Provider Information | |||||||||
| NPI: | 1497186878 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SEIDL | ||||||||
| FirstName: | MATTHEW | ||||||||
| MiddleName: | JOSEPH | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | PSY.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2925 AVENTURA BLVD STE 300 | ||||||||
| Address2: | |||||||||
| City: | AVENTURA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 331803109 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3059361002 | ||||||||
| FaxNumber: | 3059361022 | ||||||||
| Practice Location | |||||||||
| Address1: | 2925 AVENTURA BLVD STE 300 | ||||||||
| Address2: | |||||||||
| City: | AVENTURA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 331803109 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3059361002 | ||||||||
| FaxNumber: | 3059361002 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/10/2013 | ||||||||
| LastUpdateDate: | 08/24/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/24/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103T00000X | 11216 | FL | Y | Behavioral Health & Social Service Providers | Psychologist |
No ID Information.