Provider Demographics
NPI:1003055161
Name:SIEGEL, YAAKOV (PSYD)
Entity Type:Individual
Prefix:DR
First Name:YAAKOV
Middle Name:
Last Name:SIEGEL
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16300 NE 19TH AVE
Mailing Address - Street 2:SUITE 205
Mailing Address - City:NORTH MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33162-4883
Mailing Address - Country:US
Mailing Address - Phone:305-919-1718
Mailing Address - Fax:
Practice Address - Street 1:16300 NE 19TH AVE
Practice Address - Street 2:SUITE 205
Practice Address - City:NORTH MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33162-4883
Practice Address - Country:US
Practice Address - Phone:305-919-1718
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-12
Last Update Date:2009-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY7796103TC0700X, 103TF0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensic
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical