Provider Demographics
NPI:1942449509
Name:SIEGEL, MARY S (MA,NCC)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:S
Last Name:SIEGEL
Suffix:
Gender:F
Credentials:MA,NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:174 SAVANNAH PARK LOOP
Mailing Address - Street 2:
Mailing Address - City:CASSELBERRY
Mailing Address - State:FL
Mailing Address - Zip Code:32707-2806
Mailing Address - Country:US
Mailing Address - Phone:407-260-9359
Mailing Address - Fax:
Practice Address - Street 1:2100 LEE RD
Practice Address - Street 2:
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32789-1862
Practice Address - Country:US
Practice Address - Phone:407-644-7593
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-05
Last Update Date:2009-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC22015101YP1600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral