Provider Demographics
NPI:1457141806
Name:SIEGEL, BRIANNE PAXTON (MSW, LCSW, CBIS)
Entity type:Individual
Prefix:
First Name:BRIANNE
Middle Name:PAXTON
Last Name:SIEGEL
Suffix:
Gender:
Credentials:MSW, LCSW, CBIS
Other - Prefix:
Other - First Name:PAXTON
Other - Middle Name:
Other - Last Name:OLIVER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:111 TOWN SQUARE PL STE 1238 #183614
Mailing Address - Street 2:
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07310
Mailing Address - Country:US
Mailing Address - Phone:732-890-4708
Mailing Address - Fax:
Practice Address - Street 1:111 TOWN SQUARE PL STE 1238 #183614
Practice Address - Street 2:
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07310
Practice Address - Country:US
Practice Address - Phone:732-890-4708
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-08
Last Update Date:2025-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC063870001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical