Healthcare Provider Details

I. General information

NPI: 1467573873
Provider Name (Legal Business Name): JOELLE VALVO SIEGEL PSY.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2007
Last Update Date: 05/02/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6 STATE ST SUITE 413
BANGOR ME
04401-5112
US

IV. Provider business mailing address

6 STATE ST SUITE 413
BANGOR ME
04401-5112
US

V. Phone/Fax

Practice location:
  • Phone: 207-942-9600
  • Fax: 207-942-2627
Mailing address:
  • Phone: 207-942-9600
  • Fax: 207-942-2627

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPS971
License Number StateME
# 2
Primary TaxonomyN
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License NumberPS971
License Number StateME
# 3
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License NumberPS971
License Number StateME
# 4
Primary TaxonomyN
Taxonomy Code103TF0000X
TaxonomyFamily Psychologist
License NumberPS971
License Number StateME
# 5
Primary TaxonomyN
Taxonomy Code103TF0200X
TaxonomyForensic Psychologist
License NumberPS971
License Number StateME
# 6
Primary TaxonomyN
Taxonomy Code103TP2701X
TaxonomyGroup Psychotherapy Psychologist
License NumberPS971
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: