Provider Demographics
NPI:1720113152
Name:SIEGEL, B JANE (LPC LMFT)
Entity Type:Individual
Prefix:
First Name:B
Middle Name:JANE
Last Name:SIEGEL
Suffix:
Gender:F
Credentials:LPC LMFT
Other - Prefix:
Other - First Name:BARBARA
Other - Middle Name:JANE
Other - Last Name:RANDALL SIEGEL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1769 108 JAMESTOWN ROAD
Mailing Address - Street 2:JAMESTOWN PROFESSIONAL PARK
Mailing Address - City:WILLIAMSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:23185
Mailing Address - Country:US
Mailing Address - Phone:757-258-0853
Mailing Address - Fax:
Practice Address - Street 1:1769 108 JAMESTOWN ROAD
Practice Address - Street 2:JAMESTOWN PROFESSIONAL PARK
Practice Address - City:WILLIAMSBURG
Practice Address - State:VA
Practice Address - Zip Code:23185
Practice Address - Country:US
Practice Address - Phone:757-258-0853
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-23
Last Update Date:2008-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701001027101YP2500X
VA0717000222106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA19527OtherANTHEM BCBS