Provider Demographics
NPI:1184699837
Name:SIEGEL, ALAN E (EDD)
Entity type:Individual
Prefix:
First Name:ALAN
Middle Name:E
Last Name:SIEGEL
Suffix:
Gender:M
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:263 CONCORD AVE
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02138-1336
Mailing Address - Country:US
Mailing Address - Phone:617-253-4374
Mailing Address - Fax:
Practice Address - Street 1:263 CONCORD AVE
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02138-1336
Practice Address - Country:US
Practice Address - Phone:617-253-4374
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA101103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAW01310OtherBLUE CROSS
MAW01310Medicare ID - Type Unspecified