Healthcare Provider Details

I. General information

NPI: 1457025546
Provider Name (Legal Business Name): ERICA LAUREN SIEGAL, A LICENSED CLINICAL SOCIAL WORKER CORPORTATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/03/2021
Last Update Date: 08/03/2021
Certification Date: 08/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14605 WILD OAK DR
CANYON COUNTRY CA
91387-4724
US

IV. Provider business mailing address

16654 SOLEDAD CANYON RD # 548
CANYON COUNTRY CA
91387-3217
US

V. Phone/Fax

Practice location:
  • Phone: 310-486-0118
  • Fax:
Mailing address:
  • Phone: 310-486-0118
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number State

VIII. Authorized Official

Name: ERICA LAUREN SIEGAL
Title or Position: OWNER
Credential: LCSW
Phone: 310-486-0118