Provider Demographics
NPI:1992822613
Name:SIEGEL, IRENE ROBIN (LCSW)
Entity Type:Individual
Prefix:
First Name:IRENE
Middle Name:ROBIN
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 1:202 E MAIN ST
Mailing Address - Street 2:SUITE 102
Mailing Address - City:HUNTINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:11743-2993
Mailing Address - Country:US
Mailing Address - Phone:631-351-1737
Mailing Address - Fax:631-547-5434
Practice Address - Street 1:202 E MAIN ST
Practice Address - Street 2:SUITE 102
Practice Address - City:HUNTINGTON
Practice Address - State:NY
Practice Address - Zip Code:11743-2993
Practice Address - Country:US
Practice Address - Phone:631-351-1737
Practice Address - Fax:631-547-5434
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYPR019961-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY153079OtherVALUE OPTIONS PROVIDER
NY7333034OtherVALUE OPTIONS PIN
NY7333034OtherVALUE OPTIONS PIN