1417945213 NPI number — MS. MARILYN SIEGEL LCSWR

Table of content: MS. MARILYN SIEGEL LCSWR (NPI 1417945213)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1417945213 NPI number — MS. MARILYN SIEGEL LCSWR

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SIEGEL
Provider First Name:
MARILYN
Provider Middle Name:
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
LCSWR
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1417945213
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
60 1ST AVE
Provider Second Line Business Mailing Address:
9I
Provider Business Mailing Address City Name:
NEW YORK
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10009-7326
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
212-673-2737
Provider Business Mailing Address Fax Number:
212-533-3212

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
25 E 10TH ST
Provider Second Line Business Practice Location Address:
STE 2F
Provider Business Practice Location Address City Name:
NEW YORK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10003-6107
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
917-922-1826
Provider Business Practice Location Address Fax Number:
212-533-3212
Provider Enumeration Date:
10/06/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  R045207 1 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: P3519305 . This is a "OXFORD" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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