Healthcare Provider Details

I. General information

NPI: 1730944240
Provider Name (Legal Business Name): JULIE SIEGEL LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/14/2024
Last Update Date: 02/14/2024
Certification Date: 02/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20101 LAKE CHABOT RD FL 4
CASTRO VALLEY CA
94546-5305
US

IV. Provider business mailing address

3862 RHODA AVE
OAKLAND CA
94602-3323
US

V. Phone/Fax

Practice location:
  • Phone: 510-204-3410
  • Fax:
Mailing address:
  • Phone: 510-910-4983
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number17819
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: