Provider Demographics
NPI:1063574317
Name:SIEGELMAN, ABRAHAM (LCSW)
Entity type:Individual
Prefix:MR
First Name:ABRAHAM
Middle Name:
Last Name:SIEGELMAN
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:144 HARBORVIEW S
Mailing Address - Street 2:
Mailing Address - City:LAWRENCE
Mailing Address - State:NY
Mailing Address - Zip Code:11559-1908
Mailing Address - Country:US
Mailing Address - Phone:516-371-2929
Mailing Address - Fax:
Practice Address - Street 1:144 HARBORVIEW S
Practice Address - Street 2:
Practice Address - City:LAWRENCE
Practice Address - State:NY
Practice Address - Zip Code:11559-1908
Practice Address - Country:US
Practice Address - Phone:516-371-2929
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYLCSW PR000688-1103T00000X
NYLCSW PROOO688-1171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103T00000XBehavioral Health & Social Service ProvidersPsychologist
Not Answered171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYN52471Medicare ID - Type UnspecifiedPSYCHOTHERAPY