Provider Demographics
NPI:1740097252
Name:SIEGEL, CHRISTOPHER (MA)
Entity type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:
Last Name:SIEGEL
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10136 GRAND PLZ
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68134-2537
Mailing Address - Country:US
Mailing Address - Phone:531-206-2590
Mailing Address - Fax:
Practice Address - Street 1:6213 J ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68117-1148
Practice Address - Country:US
Practice Address - Phone:531-206-2590
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-17
Last Update Date:2024-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE81094456104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty