Provider Demographics
NPI:1659424844
Name:SIEBEL, MARIA LYNN (R-LCSW)
Entity Type:Individual
Prefix:MS
First Name:MARIA
Middle Name:LYNN
Last Name:SIEBEL
Suffix:
Gender:F
Credentials:R-LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:406 7TH AVE
Mailing Address - Street 2:#8
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11215-7306
Mailing Address - Country:US
Mailing Address - Phone:718-216-1280
Mailing Address - Fax:
Practice Address - Street 1:565 1ST ST
Practice Address - Street 2:APT. 2
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11215-2310
Practice Address - Country:US
Practice Address - Phone:718-369-2659
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR034144-1101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYN797410Medicare ID - Type Unspecified