Provider Demographics
NPI:1699469023
Name:SIEGAL, JENNIFER E (LMFT)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:E
Last Name:SIEGAL
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 ELIZABETH RD
Mailing Address - Street 2:
Mailing Address - City:BERLIN
Mailing Address - State:CT
Mailing Address - Zip Code:06037-4054
Mailing Address - Country:US
Mailing Address - Phone:860-966-0530
Mailing Address - Fax:
Practice Address - Street 1:111 ELIZABETH RD
Practice Address - Street 2:
Practice Address - City:BERLIN
Practice Address - State:CT
Practice Address - Zip Code:06037-4054
Practice Address - Country:US
Practice Address - Phone:860-966-0530
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-07
Last Update Date:2023-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT3129101YM0800X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health