Provider Demographics
NPI:1336584150
Name:SIEGEL, CARRIE ANNE SCHNEIDER (LCSW)
Entity Type:Individual
Prefix:
First Name:CARRIE
Middle Name:ANNE SCHNEIDER
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 1:2407 CLARK LN # A
Mailing Address - Street 2:
Mailing Address - City:REDONDO BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90278-4423
Mailing Address - Country:US
Mailing Address - Phone:818-337-8478
Mailing Address - Fax:
Practice Address - Street 1:2309 PACIFIC COAST HWY STE 103
Practice Address - Street 2:
Practice Address - City:HERMOSA BEACH
Practice Address - State:CA
Practice Address - Zip Code:90254-2752
Practice Address - Country:US
Practice Address - Phone:818-337-8478
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-07
Last Update Date:2023-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA885251041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CALCSW88525OtherLICENSE