Provider Demographics
NPI:1477867653
Name:SIEGLER, SUSAN (MS)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:
Last Name:SIEGLER
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 LEARNING LN
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:ME
Mailing Address - Zip Code:04938-7039
Mailing Address - Country:US
Mailing Address - Phone:207-778-9517
Mailing Address - Fax:
Practice Address - Street 1:115 LEARNING LN
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:ME
Practice Address - Zip Code:04938-7039
Practice Address - Country:US
Practice Address - Phone:207-778-9517
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-30
Last Update Date:2010-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool