Provider Demographics
NPI:1689763641
Name:SIEGEL, DANIEL A (LCSW)
Entity Type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:A
Last Name:SIEGEL
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:KINGSTON
Mailing Address - State:NY
Mailing Address - Zip Code:12401-3828
Mailing Address - Country:US
Mailing Address - Phone:845-340-0881
Mailing Address - Fax:845-338-0282
Practice Address - Street 1:44 MAIN ST
Practice Address - Street 2:
Practice Address - City:KINGSTON
Practice Address - State:NY
Practice Address - Zip Code:12401-3828
Practice Address - Country:US
Practice Address - Phone:845-340-0881
Practice Address - Fax:845-338-0282
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR0337541041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYN45493Medicare ID - Type Unspecified