Provider Demographics
NPI:1467533919
Name:SIEG, DANIEL BROOKS (MSW, LCSW)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:BROOKS
Last Name:SIEG
Suffix:
Gender:M
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:883 BELLE AVE
Mailing Address - Street 2:
Mailing Address - City:TEANECK
Mailing Address - State:NJ
Mailing Address - Zip Code:07666-2536
Mailing Address - Country:US
Mailing Address - Phone:201-692-0834
Mailing Address - Fax:718-796-4614
Practice Address - Street 1:750 ASTOR AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10467-9304
Practice Address - Country:US
Practice Address - Phone:718-882-5000
Practice Address - Fax:718-798-7633
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-18
Last Update Date:2009-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR027124-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ641868Medicare ID - Type Unspecified
NYN61521Medicare ID - Type Unspecified