Provider Demographics
NPI:1750443727
Name:SIEGEL, EDWARD J (LCSW)
Entity Type:Individual
Prefix:MR
First Name:EDWARD
Middle Name:J
Last Name:SIEGEL
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
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Mailing Address - Street 1:137 BARROW ST
Mailing Address - Street 2:APT 3B
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10014-6319
Mailing Address - Country:US
Mailing Address - Phone:212-627-1742
Mailing Address - Fax:888-965-7704
Practice Address - Street 1:80 5TH AVE
Practice Address - Street 2:RM 903
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10011-7611
Practice Address - Country:US
Practice Address - Phone:718-625-3985
Practice Address - Fax:212-675-0786
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-15
Last Update Date:2018-06-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NYPR02172611041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYN15601Medicare ID - Type Unspecified