Provider Demographics
NPI:1578781183
Name:SIEGEL, JUDITH H (PHD, MFT(INACTIVE)
Entity Type:Individual
Prefix:DR
First Name:JUDITH
Middle Name:H
Last Name:SIEGEL
Suffix:
Gender:F
Credentials:PHD, MFT(INACTIVE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:51 E CAMPBELL AVE
Mailing Address - Street 2:SUITE 170
Mailing Address - City:CAMPBELL
Mailing Address - State:CA
Mailing Address - Zip Code:95008-2047
Mailing Address - Country:US
Mailing Address - Phone:408-370-6156
Mailing Address - Fax:
Practice Address - Street 1:51 E CAMPBELL AVE
Practice Address - Street 2:SUITE 170
Practice Address - City:CAMPBELL
Practice Address - State:CA
Practice Address - Zip Code:95008-2047
Practice Address - Country:US
Practice Address - Phone:408-370-6156
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-22
Last Update Date:2010-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY11277103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist