Provider Demographics
NPI:1811570104
Name:SIEGELMAN, IRENE (LAC)
Entity Type:Individual
Prefix:MRS
First Name:IRENE
Middle Name:
Last Name:SIEGELMAN
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:92 LESLIE ST
Mailing Address - Street 2:
Mailing Address - City:EDISON
Mailing Address - State:NJ
Mailing Address - Zip Code:08817-2932
Mailing Address - Country:US
Mailing Address - Phone:908-510-0857
Mailing Address - Fax:
Practice Address - Street 1:92 LESLIE ST
Practice Address - Street 2:
Practice Address - City:EDISON
Practice Address - State:NJ
Practice Address - Zip Code:08817-2932
Practice Address - Country:US
Practice Address - Phone:908-510-0857
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-04
Last Update Date:2021-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37AC00576600101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health