Provider Demographics
NPI:1063507713
Name:SIEGEL, LYNN C (PSYD)
Entity Type:Individual
Prefix:DR
First Name:LYNN
Middle Name:C
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:PO BOX 5684
Mailing Address - Street 2:
Mailing Address - City:OXNARD
Mailing Address - State:CA
Mailing Address - Zip Code:93031-5684
Mailing Address - Country:US
Mailing Address - Phone:310-268-2538
Mailing Address - Fax:310-235-2784
Practice Address - Street 1:22231 MULHOLLAND HWY STE 106
Practice Address - Street 2:
Practice Address - City:CALABASAS
Practice Address - State:CA
Practice Address - Zip Code:91302-5178
Practice Address - Country:US
Practice Address - Phone:818-222-9300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2020-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071.004866103TC0700X
CAPSY 15371103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical