Provider Demographics
NPI:1164527081
Name:SEIBRING, ANGEL R (PHD)
Entity Type:Individual
Prefix:
First Name:ANGEL
Middle Name:R
Last Name:SEIBRING
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 1:259 MASSACHUSETTS AVE
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:02474-8406
Mailing Address - Country:US
Mailing Address - Phone:781-648-0881
Mailing Address - Fax:781-646-9351
Practice Address - Street 1:259 MASSACHUSETTS AVE
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:MA
Practice Address - Zip Code:02474-8406
Practice Address - Country:US
Practice Address - Phone:781-648-0881
Practice Address - Fax:781-646-9351
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-14
Last Update Date:2010-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA6811103T00000X, 103TB0200X, 103TC0700X, 103TF0000X, 103TH0100X, 103TP2701X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
No103TF0000XBehavioral Health & Social Service ProvidersPsychologistFamily
No103TH0100XBehavioral Health & Social Service ProvidersPsychologistHealth Service
No103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup Psychotherapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MASEW50346Medicare ID - Type Unspecified