Provider Demographics
NPI:1700149879
Name:SIEGEL, REBECCA SAVOY (PHD)
Entity type:Individual
Prefix:DR
First Name:REBECCA
Middle Name:SAVOY
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:PO BOX 776351
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60677-6351
Mailing Address - Country:US
Mailing Address - Phone:502-588-9490
Mailing Address - Fax:502-272-5116
Practice Address - Street 1:4123 DUTCHMANS LANE
Practice Address - Street 2:SUITE 307
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40207-4721
Practice Address - Country:US
Practice Address - Phone:502-409-5600
Practice Address - Fax:502-259-3078
Is Sole Proprietor?:No
Enumeration Date:2012-06-22
Last Update Date:2021-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4334103TC0700X, 103TC2200X
KYPSYLIP00211362103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100387330Medicaid
KY000000973218OtherANTHEM
KY208486OtherSIHO
KY50102071OtherPASSPORT
KY50102071OtherPASSPORT