Provider Demographics
NPI:1760053706
Name:ELIZABETH M SIEGEL, PLC
Entity Type:Organization
Organization Name:ELIZABETH M SIEGEL, PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOTHERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:M
Authorized Official - Last Name:SIEGEL
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW
Authorized Official - Phone:248-930-9686
Mailing Address - Street 1:1861 EATON RD
Mailing Address - Street 2:
Mailing Address - City:BERKLEY
Mailing Address - State:MI
Mailing Address - Zip Code:48072-1726
Mailing Address - Country:US
Mailing Address - Phone:248-930-9686
Mailing Address - Fax:
Practice Address - Street 1:1861 EATON RD
Practice Address - Street 2:
Practice Address - City:BERKLEY
Practice Address - State:MI
Practice Address - Zip Code:48072-1726
Practice Address - Country:US
Practice Address - Phone:248-930-9686
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-09
Last Update Date:2021-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)