Provider Demographics
NPI:1154327211
Name:SIEGEL, CAROL F (PHD)
Entity Type:Individual
Prefix:DR
First Name:CAROL
Middle Name:F
Last Name:SIEGEL
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1516 W LAKE ST
Mailing Address - Street 2:STE 214
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55408-2554
Mailing Address - Country:US
Mailing Address - Phone:612-825-4307
Mailing Address - Fax:612-821-4349
Practice Address - Street 1:1516 W LAKE ST
Practice Address - Street 2:STE 214
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55408-2554
Practice Address - Country:US
Practice Address - Phone:612-825-4307
Practice Address - Fax:612-821-4349
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP4422103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN600R5SIOtherBLUE CROSS BLUE SHIELD