Provider Demographics
NPI:1558373373
Name:SIEBER, MICHAEL RAY (MSW)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:RAY
Last Name:SIEBER
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:RR 2 BOX 302
Mailing Address - Street 2:
Mailing Address - City:MANNINGTON
Mailing Address - State:WV
Mailing Address - Zip Code:26582-9106
Mailing Address - Country:US
Mailing Address - Phone:304-795-4582
Mailing Address - Fax:
Practice Address - Street 1:RR 2 BOX 233-B
Practice Address - Street 2:
Practice Address - City:MOUNT CLARE
Practice Address - State:WV
Practice Address - Zip Code:26408-9719
Practice Address - Country:US
Practice Address - Phone:304-622-6404
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV582101YP2500X
WVDP004551441041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WVSW00382Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER