Provider Demographics
NPI:1225510449
Name:SIEGEL, LAUREN JO (LICSW)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:JO
Last Name:SIEGEL
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:916 BELMONT ST
Mailing Address - Street 2:
Mailing Address - City:WATERTOWN
Mailing Address - State:MA
Mailing Address - Zip Code:02472-1024
Mailing Address - Country:US
Mailing Address - Phone:781-953-3007
Mailing Address - Fax:
Practice Address - Street 1:10 LONGWOOD DR
Practice Address - Street 2:
Practice Address - City:WESTWOOD
Practice Address - State:MA
Practice Address - Zip Code:02090-1123
Practice Address - Country:US
Practice Address - Phone:781-329-4433
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-04
Last Update Date:2018-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10249911041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical