Provider Demographics
NPI:1881314045
Name:SEIGEL, LAURA ELLEN (MSW, RCSWI)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:ELLEN
Last Name:SEIGEL
Suffix:
Gender:F
Credentials:MSW, RCSWI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6202 BUENA VISTA DR
Mailing Address - Street 2:
Mailing Address - City:MARGATE
Mailing Address - State:FL
Mailing Address - Zip Code:33063-8362
Mailing Address - Country:US
Mailing Address - Phone:786-423-2205
Mailing Address - Fax:
Practice Address - Street 1:800 NE 62ND ST STE 408
Practice Address - Street 2:
Practice Address - City:FT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33334-3522
Practice Address - Country:US
Practice Address - Phone:954-205-7391
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-29
Last Update Date:2022-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLISW17286101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional