Provider Demographics
NPI:1467573873
Name:SIEGEL, JOELLE VALVO (PSYD)
Entity Type:Individual
Prefix:
First Name:JOELLE
Middle Name:VALVO
Last Name:SIEGEL
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 STATE ST
Mailing Address - Street 2:SUITE 413
Mailing Address - City:BANGOR
Mailing Address - State:ME
Mailing Address - Zip Code:04401-5112
Mailing Address - Country:US
Mailing Address - Phone:207-942-9600
Mailing Address - Fax:207-942-2627
Practice Address - Street 1:6 STATE ST
Practice Address - Street 2:SUITE 413
Practice Address - City:BANGOR
Practice Address - State:ME
Practice Address - Zip Code:04401-5112
Practice Address - Country:US
Practice Address - Phone:207-942-9600
Practice Address - Fax:207-942-2627
Is Sole Proprietor?:No
Enumeration Date:2007-04-03
Last Update Date:2016-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPS971103TC0700X, 103TB0200X, 103TC2200X, 103TF0000X, 103TF0200X, 103TP2701X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
No103TF0000XBehavioral Health & Social Service ProvidersPsychologistFamily
No103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensic
No103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup Psychotherapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME289950000Medicaid