Provider Demographics
NPI:1689881542
Name:SIEGMAN, ANITA B (PHD)
Entity Type:Individual
Prefix:DR
First Name:ANITA
Middle Name:B
Last Name:SIEGMAN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11980 SAN VICENTE BLVD
Mailing Address - Street 2:SUITE 709
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90049-6606
Mailing Address - Country:US
Mailing Address - Phone:310-476-1416
Mailing Address - Fax:310-820-0390
Practice Address - Street 1:11980 SAN VICENTE BLVD
Practice Address - Street 2:SUITE 709
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90049-6606
Practice Address - Country:US
Practice Address - Phone:310-476-1416
Practice Address - Fax:310-820-0390
Is Sole Proprietor?:No
Enumeration Date:2007-05-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY6613103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical