Provider Demographics
NPI:1003860503
Name:SPIEGEL, MILDRED LIBBA (MS)
Entity Type:Individual
Prefix:
First Name:MILDRED
Middle Name:LIBBA
Last Name:SPIEGEL
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 SHADY AVE
Mailing Address - Street 2:C104
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15206-4409
Mailing Address - Country:US
Mailing Address - Phone:412-362-7955
Mailing Address - Fax:412-422-8807
Practice Address - Street 1:401 SHADY AVE
Practice Address - Street 2:C104
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15206-4409
Practice Address - Country:US
Practice Address - Phone:412-362-7955
Practice Address - Fax:412-422-8807
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-19
Last Update Date:2007-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS006906L103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA376425OtherHIGHMARK #