Provider Demographics
NPI:1437277910
Name:SIEGEL, GILLIAN EMILY (LCSW)
Entity Type:Individual
Prefix:
First Name:GILLIAN
Middle Name:EMILY
Last Name:SIEGEL
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:EMILY
Other - Middle Name:GILLIAN
Other - Last Name:SIEGEL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:507 S 4TH ST
Mailing Address - Street 2:
Mailing Address - City:LARAMIE
Mailing Address - State:WY
Mailing Address - Zip Code:82070-3753
Mailing Address - Country:US
Mailing Address - Phone:307-399-4508
Mailing Address - Fax:
Practice Address - Street 1:507 S 4TH ST
Practice Address - Street 2:
Practice Address - City:LARAMIE
Practice Address - State:WY
Practice Address - Zip Code:82070-3753
Practice Address - Country:US
Practice Address - Phone:307-399-4508
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-26
Last Update Date:2012-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0751271041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical