Provider Demographics
NPI:1457025546
Name:ERICA LAUREN SIEGAL, A LICENSED CLINICAL SOCIAL WORKER CORPORTATION
Entity Type:Organization
Organization Name:ERICA LAUREN SIEGAL, A LICENSED CLINICAL SOCIAL WORKER CORPORTATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ERICA
Authorized Official - Middle Name:LAUREN
Authorized Official - Last Name:SIEGAL
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:310-486-0118
Mailing Address - Street 1:16654 SOLEDAD CANYON RD # 548
Mailing Address - Street 2:
Mailing Address - City:CANYON COUNTRY
Mailing Address - State:CA
Mailing Address - Zip Code:91387-3217
Mailing Address - Country:US
Mailing Address - Phone:310-486-0118
Mailing Address - Fax:
Practice Address - Street 1:14605 WILD OAK DR
Practice Address - Street 2:
Practice Address - City:CANYON COUNTRY
Practice Address - State:CA
Practice Address - Zip Code:91387-4724
Practice Address - Country:US
Practice Address - Phone:310-486-0118
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-03
Last Update Date:2021-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty
No172V00000XOther Service ProvidersCommunity Health WorkerGroup - Multi-Specialty
No175T00000XOther Service ProvidersPeer SpecialistGroup - Multi-Specialty