Provider Demographics
NPI:1811264583
Name:SIEGEL, DANA CAROLINE (MED, BCBA, LBS)
Entity type:Individual
Prefix:MISS
First Name:DANA
Middle Name:CAROLINE
Last Name:SIEGEL
Suffix:
Gender:F
Credentials:MED, BCBA, LBS
Other - Prefix:MISS
Other - First Name:DANA
Other - Middle Name:CAROLINE
Other - Last Name:DORN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MED, BCBA
Mailing Address - Street 1:240 WINDING WAY
Mailing Address - Street 2:
Mailing Address - City:TELFORD
Mailing Address - State:PA
Mailing Address - Zip Code:18969-2165
Mailing Address - Country:US
Mailing Address - Phone:610-715-3240
Mailing Address - Fax:801-697-5403
Practice Address - Street 1:240 WINDING WAY
Practice Address - Street 2:
Practice Address - City:TELFORD
Practice Address - State:PA
Practice Address - Zip Code:18969-2165
Practice Address - Country:US
Practice Address - Phone:610-715-3240
Practice Address - Fax:801-697-5403
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-24
Last Update Date:2016-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1-11-9489103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst