Provider Demographics
NPI:1336252725
Name:SIEGEL, ANDREW (LCSW)
Entity Type:Individual
Prefix:MR
First Name:ANDREW
Middle Name:
Last Name:SIEGEL
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:165 W END AVE
Mailing Address - Street 2:APT. 14F
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10023-5503
Mailing Address - Country:US
Mailing Address - Phone:212-724-2385
Mailing Address - Fax:
Practice Address - Street 1:27 BARROW ST
Practice Address - Street 2:3RD FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10014-3823
Practice Address - Country:US
Practice Address - Phone:212-242-1762
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY071111101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYNF4821Medicare ID - Type Unspecified