Provider Demographics
NPI:1124445291
Name:SIEBERT, MARK (LCSW)
Entity type:Individual
Prefix:MR
First Name:MARK
Middle Name:
Last Name:SIEBERT
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:MARK
Other - Middle Name:
Other - Last Name:SIEBERT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:1458 E 820 N
Mailing Address - Street 2:
Mailing Address - City:OREM
Mailing Address - State:UT
Mailing Address - Zip Code:84097
Mailing Address - Country:US
Mailing Address - Phone:801-860-4780
Mailing Address - Fax:385-375-6087
Practice Address - Street 1:1458 E 820 N
Practice Address - Street 2:
Practice Address - City:OREM
Practice Address - State:UT
Practice Address - Zip Code:84097
Practice Address - Country:US
Practice Address - Phone:801-860-4780
Practice Address - Fax:385-375-6087
Is Sole Proprietor?:No
Enumeration Date:2014-03-26
Last Update Date:2023-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5958473-35011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical