Provider Demographics
NPI:1336317841
Name:SIEGEL, LINDA ELLEN (MPS, ATR-BC,LCAT)
Entity Type:Individual
Prefix:MS
First Name:LINDA
Middle Name:ELLEN
Last Name:SIEGEL
Suffix:
Gender:F
Credentials:MPS, ATR-BC,LCAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 PLAZA ST W
Mailing Address - Street 2:SUITE 1D
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11217-3748
Mailing Address - Country:US
Mailing Address - Phone:212-622-1833
Mailing Address - Fax:
Practice Address - Street 1:1 PLAZA ST W
Practice Address - Street 2:SUITE 1D
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11217-3748
Practice Address - Country:US
Practice Address - Phone:212-622-1833
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-19
Last Update Date:2008-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000362-1101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health