Provider Demographics
NPI:1336358779
Name:BOBETTE SMITH SIEGEL MSW LLC
Entity Type:Organization
Organization Name:BOBETTE SMITH SIEGEL MSW LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BOBETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:SIEGEL
Authorized Official - Suffix:
Authorized Official - Credentials:MSW
Authorized Official - Phone:480-948-6222
Mailing Address - Street 1:14362 N FRANK LLOYD WRIGHT BLVD STE 1000
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85260-8847
Mailing Address - Country:US
Mailing Address - Phone:480-948-6222
Mailing Address - Fax:480-219-9970
Practice Address - Street 1:14362 N FRANK LLOYD WRIGHT BLVD STE 1000
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85260
Practice Address - Country:US
Practice Address - Phone:480-948-6222
Practice Address - Fax:480-219-9970
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-22
Last Update Date:2018-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLCSW 109011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
Z115285Medicare PIN