Healthcare Provider Details

I. General information

NPI: 1740200716
Provider Name (Legal Business Name): FRANCINE SIEGEL FERN LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: FRANCINE SIEGEL LCSW

II. Dates (important events)

Enumeration Date: 07/20/2006
Last Update Date: 07/20/2024
Certification Date: 07/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1647 SUN CITY CENTER PLZ STE 204B
SUN CITY CENTER FL
33573-5334
US

IV. Provider business mailing address

16162 COQUINA BAY LN
WIMAUMA FL
33598-4060
US

V. Phone/Fax

Practice location:
  • Phone: 813-419-4096
  • Fax:
Mailing address:
  • Phone: 813-419-4096
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberR051959-1
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW9131
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: