Healthcare Provider Details

I. General information

NPI: 1336317841
Provider Name (Legal Business Name): LINDA ELLEN SIEGEL MPS, ATR-BC,LCAT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/19/2008
Last Update Date: 02/19/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 PLAZA ST W SUITE 1D
BROOKLYN NY
11217-3748
US

IV. Provider business mailing address

1 PLAZA ST W SUITE 1D
BROOKLYN NY
11217-3748
US

V. Phone/Fax

Practice location:
  • Phone: 212-622-1833
  • Fax:
Mailing address:
  • Phone: 212-622-1833
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number000362-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: