Healthcare Provider Details

I. General information

NPI: 1396074837
Provider Name (Legal Business Name): MATTHEW PHILIP SIEGEL PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/11/2009
Last Update Date: 11/20/2025
Certification Date: 11/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

279 PROSPECT PARK W APT 1I
BROOKLYN NY
11215-6273
US

IV. Provider business mailing address

279 PROSPECT PARK W APT 1I
BROOKLYN NY
11215-6273
US

V. Phone/Fax

Practice location:
  • Phone: 917-439-3141
  • Fax:
Mailing address:
  • Phone: 917-439-3141
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number7771286
License Number StateID
# 2
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number019172
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: