Provider Demographics
NPI:1245428200
Name:IRENE R. SIEGEL LCSW PLLC
Entity type:Organization
Organization Name:IRENE R. SIEGEL LCSW PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER SOLE PROPRIETOR
Authorized Official - Prefix:MS
Authorized Official - First Name:IRENE
Authorized Official - Middle Name:R
Authorized Official - Last Name:SIEGEL
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:631-351-1737
Mailing Address - Street 1:202 E MAIN ST
Mailing Address - Street 2:SUITE 102
Mailing Address - City:HUNTINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:11743-2993
Mailing Address - Country:US
Mailing Address - Phone:631-351-1737
Mailing Address - Fax:631-547-5434
Practice Address - Street 1:202 E MAIN ST
Practice Address - Street 2:SUITE 102
Practice Address - City:HUNTINGTON
Practice Address - State:NY
Practice Address - Zip Code:11743-2993
Practice Address - Country:US
Practice Address - Phone:631-351-1737
Practice Address - Fax:631-547-5434
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-04
Last Update Date:2007-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty