Provider Demographics
NPI:1366401069
Name:SIEGEL, RONALD D (PSYD)
Entity type:Individual
Prefix:DR
First Name:RONALD
Middle Name:D
Last Name:SIEGEL
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 LONGMEADOW RD
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:MA
Mailing Address - Zip Code:01773-4810
Mailing Address - Country:US
Mailing Address - Phone:781-259-3434
Mailing Address - Fax:
Practice Address - Street 1:20 LONGMEADOW RD
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:MA
Practice Address - Zip Code:01773-4810
Practice Address - Country:US
Practice Address - Phone:781-259-3434
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-21
Last Update Date:2011-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3585103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAW03629OtherBLUE SHIELD OF MASS.
MA0514586Medicaid
MAW03629Medicare ID - Type Unspecified