Provider Demographics
NPI:1407071210
Name:SIEGLER, JUDITH CAROL (PHD, LMFT)
Entity Type:Individual
Prefix:DR
First Name:JUDITH
Middle Name:CAROL
Last Name:SIEGLER
Suffix:
Gender:F
Credentials:PHD, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:728 E LINCOLN AVE
Mailing Address - Street 2:SUITE 4
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32901-4806
Mailing Address - Country:US
Mailing Address - Phone:321-722-9990
Mailing Address - Fax:321-768-0180
Practice Address - Street 1:728 E LINCOLN AVE
Practice Address - Street 2:SUITE 4
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32901-4806
Practice Address - Country:US
Practice Address - Phone:321-722-9990
Practice Address - Fax:321-768-0180
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMT 1723106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist