Provider Demographics
NPI:1396967378
Name:SIEGEL, ALEX M (JD,PHD)
Entity type:Individual
Prefix:DR
First Name:ALEX
Middle Name:M
Last Name:SIEGEL
Suffix:
Gender:M
Credentials:JD,PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:915 MONTGOMERY AVE
Mailing Address - Street 2:SUITE 210
Mailing Address - City:NARBERTH
Mailing Address - State:PA
Mailing Address - Zip Code:19072-1548
Mailing Address - Country:US
Mailing Address - Phone:610-668-4240
Mailing Address - Fax:610-668-2059
Practice Address - Street 1:915 MONTGOMERY AVE
Practice Address - Street 2:SUITE 210
Practice Address - City:NARBERTH
Practice Address - State:PA
Practice Address - Zip Code:19072-1548
Practice Address - Country:US
Practice Address - Phone:610-668-4240
Practice Address - Fax:610-668-2059
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS-005568-L103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist