Provider Demographics
NPI:1417945213
Name:SIEGEL, MARILYN (LCSWR)
Entity Type:Individual
Prefix:MS
First Name:MARILYN
Middle Name:
Last Name:SIEGEL
Suffix:
Gender:F
Credentials:LCSWR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:60 1ST AVE
Mailing Address - Street 2:9I
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10009-7326
Mailing Address - Country:US
Mailing Address - Phone:212-673-2737
Mailing Address - Fax:212-533-3212
Practice Address - Street 1:25 E 10TH ST
Practice Address - Street 2:STE 2F
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10003-6107
Practice Address - Country:US
Practice Address - Phone:917-922-1826
Practice Address - Fax:212-533-3212
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR045207 11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYP3519305OtherOXFORD