Provider Demographics
NPI:1700966199
Name:SIEGEL, JUDITH A (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:JUDITH
Middle Name:A
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 1:5010 BANYAN LN
Mailing Address - Street 2:
Mailing Address - City:TAMARAC
Mailing Address - State:FL
Mailing Address - Zip Code:33319-3520
Mailing Address - Country:US
Mailing Address - Phone:954-730-9821
Mailing Address - Fax:954-777-3132
Practice Address - Street 1:1515 N UNIVERSITY DR
Practice Address - Street 2:SUITE 116A
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33071-6096
Practice Address - Country:US
Practice Address - Phone:954-752-0460
Practice Address - Fax:954-752-4542
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW27441041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLZ4040Medicare ID - Type Unspecified