Provider Demographics
NPI:1518984095
Name:SIEGEL, JON DAVID (LCSW)
Entity Type:Individual
Prefix:MR
First Name:JON
Middle Name:DAVID
Last Name:SIEGEL
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 82425
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85071-2425
Mailing Address - Country:US
Mailing Address - Phone:602-993-7220
Mailing Address - Fax:602-993-3200
Practice Address - Street 1:4232 N BROWN AVE
Practice Address - Street 2:SUITE 4
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85251-3996
Practice Address - Country:US
Practice Address - Phone:602-993-7220
Practice Address - Fax:602-993-3200
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZSW 0283I103TA0700X, 103T00000X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103TA0700XBehavioral Health & Social Service ProvidersPsychologistAdult Development & Aging
Not Answered103T00000XBehavioral Health & Social Service ProvidersPsychologist
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ805ABMedicare ID - Type UnspecifiedPROVIDER