Provider Demographics
NPI:1477033454
Name:SIEGEL, RICHARD M (PHD, LMHC, CST)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:M
Last Name:SIEGEL
Suffix:
Gender:M
Credentials:PHD, LMHC, CST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9912 KAMENA CIR
Mailing Address - Street 2:
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33436-3965
Mailing Address - Country:US
Mailing Address - Phone:561-809-1080
Mailing Address - Fax:
Practice Address - Street 1:2255 GLADES RD STE 324A
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33431-8571
Practice Address - Country:US
Practice Address - Phone:561-809-1080
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-18
Last Update Date:2018-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH6771101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health