Provider Demographics
NPI:1871676239
Name:SIEGEL, LOUISE (LCSW)
Entity Type:Individual
Prefix:MS
First Name:LOUISE
Middle Name:
Last Name:SIEGEL
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:73 CARLTON AVE APT D53
Mailing Address - Street 2:
Mailing Address - City:PORT WASHINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:11050-3549
Mailing Address - Country:US
Mailing Address - Phone:516-767-0278
Mailing Address - Fax:
Practice Address - Street 1:73 CARLTON AVE APT D53
Practice Address - Street 2:
Practice Address - City:PORT WASHINGTON
Practice Address - State:NY
Practice Address - Zip Code:11050-3549
Practice Address - Country:US
Practice Address - Phone:516-767-0278
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-21
Last Update Date:2013-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR016337-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYN7T791Medicare ID - Type Unspecified
NYN7T791Medicare PIN