Provider Demographics
NPI:1275669350
Name:SIEGEL, CAROL SUSAN (MFT28726)
Entity Type:Individual
Prefix:MS
First Name:CAROL
Middle Name:SUSAN
Last Name:SIEGEL
Suffix:
Gender:F
Credentials:MFT28726
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4845 HARTWICK ST
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90041
Mailing Address - Country:US
Mailing Address - Phone:323-957-4753
Mailing Address - Fax:323-256-0536
Practice Address - Street 1:4845 HARTWICK ST
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90041
Practice Address - Country:US
Practice Address - Phone:323-957-4753
Practice Address - Fax:323-256-0536
Is Sole Proprietor?:No
Enumeration Date:2007-02-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFT28727106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist