Provider Demographics
NPI:1639864713
Name:SIEGEL, JESSICA GAIL (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:GAIL
Last Name:SIEGEL
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MRS
Other - First Name:JESSICA
Other - Middle Name:GAIL
Other - Last Name:TAXMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:840 POST RD E
Mailing Address - Street 2:
Mailing Address - City:WESTPORT
Mailing Address - State:CT
Mailing Address - Zip Code:06880-5236
Mailing Address - Country:US
Mailing Address - Phone:203-828-0868
Mailing Address - Fax:203-822-7624
Practice Address - Street 1:840 POST RD E
Practice Address - Street 2:
Practice Address - City:WESTPORT
Practice Address - State:CT
Practice Address - Zip Code:06880-5236
Practice Address - Country:US
Practice Address - Phone:203-828-0868
Practice Address - Fax:203-822-7624
Is Sole Proprietor?:No
Enumeration Date:2023-04-06
Last Update Date:2023-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT128891041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical