Provider Demographics
NPI:1033545611
Name:SIEGFRIED, DODY STAR (MAPC)
Entity Type:Individual
Prefix:
First Name:DODY
Middle Name:STAR
Last Name:SIEGFRIED
Suffix:
Gender:F
Credentials:MAPC
Other - Prefix:
Other - First Name:DODY
Other - Middle Name:STAR
Other - Last Name:FREED
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MDIV
Mailing Address - Street 1:2650 NORTHWOOD AVE.
Mailing Address - Street 2:
Mailing Address - City:EASTON
Mailing Address - State:PENNSYLVANIA
Mailing Address - Zip Code:18045
Mailing Address - Country:UM
Mailing Address - Phone:610-250-0752
Mailing Address - Fax:
Practice Address - Street 1:51 MARKET ST
Practice Address - Street 2:
Practice Address - City:BANGOR
Practice Address - State:PA
Practice Address - Zip Code:18013-1901
Practice Address - Country:US
Practice Address - Phone:610-588-9109
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-16
Last Update Date:2013-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health