1811264583 NPI number — MISS DANA CAROLINE SIEGEL M.ED., BCBA, LBS

Table of content: MISS DANA CAROLINE SIEGEL M.ED., BCBA, LBS (NPI 1811264583)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1811264583 NPI number — MISS DANA CAROLINE SIEGEL M.ED., BCBA, LBS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SIEGEL
Provider First Name:
DANA
Provider Middle Name:
CAROLINE
Provider Name Prefix Text:
MISS
Provider Name Suffix Text:
Provider Credential Text:
M.ED., BCBA, LBS
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
DORN
Provider Other First Name:
DANA
Provider Other Middle Name:
CAROLINE
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.ED., BCBA
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1811264583
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/29/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
240 WINDING WAY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TELFORD
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
18969-2165
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
610-715-3240
Provider Business Mailing Address Fax Number:
801-697-5403

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
240 WINDING WAY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TELFORD
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18969-2165
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-715-3240
Provider Business Practice Location Address Fax Number:
801-697-5403
Provider Enumeration Date:
11/24/2011

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: 103K00000X , with the licence number:  1-11-9489 ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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