Provider Demographics
NPI:1306957170
Name:SIEGEL, GARY (LCSWR)
Entity type:Individual
Prefix:MR
First Name:GARY
Middle Name:
Last Name:SIEGEL
Suffix:
Gender:M
Credentials:LCSWR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:73 CHESTNUT ST
Mailing Address - Street 2:
Mailing Address - City:RHINEBECK
Mailing Address - State:NY
Mailing Address - Zip Code:12572-1512
Mailing Address - Country:US
Mailing Address - Phone:845-876-1378
Mailing Address - Fax:845-876-1378
Practice Address - Street 1:8 GARDEN ST
Practice Address - Street 2:
Practice Address - City:RHINEBECK
Practice Address - State:NY
Practice Address - Zip Code:12572-1357
Practice Address - Country:US
Practice Address - Phone:845-876-1378
Practice Address - Fax:845-876-1378
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0396191041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical