Provider Demographics
NPI:1972674497
Name:SIEGEL, JUDITH G (LICSW)
Entity Type:Individual
Prefix:MRS
First Name:JUDITH
Middle Name:G
Last Name:SIEGEL
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:66 CENTRAL ST
Mailing Address - Street 2:SUITE # 12
Mailing Address - City:WELLESLEY
Mailing Address - State:MA
Mailing Address - Zip Code:02482-5818
Mailing Address - Country:US
Mailing Address - Phone:617-497-5955
Mailing Address - Fax:
Practice Address - Street 1:66 CENTRAL ST
Practice Address - Street 2:SUITE # 12
Practice Address - City:WELLESLEY
Practice Address - State:MA
Practice Address - Zip Code:02482-5818
Practice Address - Country:US
Practice Address - Phone:617-497-5955
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10305581041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical