Healthcare Provider Details

I. General information

NPI: 1083360598
Provider Name (Legal Business Name): RYANN NICOLE SIEGEL PSYCHOLOGY ASSOCIATE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/23/2022
Last Update Date: 02/23/2022
Certification Date: 02/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9649 BELAIR RD STE 104
NOTTINGHAM MD
21236-1117
US

IV. Provider business mailing address

1040 DEER RIDGE DR APT 108
BALTIMORE MD
21210-2559
US

V. Phone/Fax

Practice location:
  • Phone: 410-529-1309
  • Fax:
Mailing address:
  • Phone: 240-994-9670
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberA0696
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: