Provider Demographics
NPI:1629151253
Name:SIEGL, DOROTHY M (MSW ACSW)
Entity Type:Individual
Prefix:MS
First Name:DOROTHY
Middle Name:M
Last Name:SIEGL
Suffix:
Gender:F
Credentials:MSW ACSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1560 BEAVER ST
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48128-1475
Mailing Address - Country:US
Mailing Address - Phone:313-278-5821
Mailing Address - Fax:
Practice Address - Street 1:24110 CHERRY HILL ST
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48124-1356
Practice Address - Country:US
Practice Address - Phone:313-274-4570
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010635291041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI11642100OtherMHN
MI11642100OtherMHN