Healthcare Provider Details

I. General information

NPI: 1427354695
Provider Name (Legal Business Name): CHRISTINA M. SIEGEL L.C.S.W
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CHRISTINA M. NARDO L.C.S.W

II. Dates (important events)

Enumeration Date: 02/04/2011
Last Update Date: 08/23/2021
Certification Date: 08/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

606 JOHNSON AVE
BOHEMIA NY
11716-2686
US

IV. Provider business mailing address

190 SHELTER LN
LEVITTOWN NY
11756-2733
US

V. Phone/Fax

Practice location:
  • Phone: 786-457-4242
  • Fax:
Mailing address:
  • Phone: 786-457-4242
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number0862721
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number082159
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number082159-1
License Number StateNY

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: