Provider Demographics
NPI:1356532394
Name:SIEGEL, SAMMI L (PHD)
Entity type:Individual
Prefix:DR
First Name:SAMMI
Middle Name:L
Last Name:SIEGEL
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5900 SW 73RD ST
Mailing Address - Street 2:SUITE 207
Mailing Address - City:SOUTH MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33143-5151
Mailing Address - Country:US
Mailing Address - Phone:305-613-1101
Mailing Address - Fax:305-661-6998
Practice Address - Street 1:5900 SW 73RD ST
Practice Address - Street 2:SUITE 207
Practice Address - City:SOUTH MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33143-5151
Practice Address - Country:US
Practice Address - Phone:305-613-1101
Practice Address - Fax:305-661-6998
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-06
Last Update Date:2013-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301009907103TC0700X
FLMH9105101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical