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General NPI Number Information
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NPI Number | 1124149513
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Entity Type | Individual
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Provider Name | JON HOWARD SIEGEL PH.D.
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Gender | Male
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Dates
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Enumeration Date | 04/03/2007
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Last Update Date | 09/11/2025
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Provider Practice Location Address
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Address Line | 6 STATE ST SUITE 413
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City | BANGOR
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State | ME
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Zip | 04401-5112
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Country | US
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Telephone | 207-942-2627
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Fax | 207-942-2627
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Provider Business Mailing Address
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Address Line | 6 STATE ST SUITE 413
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City | BANGOR
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State | ME
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Zip | 04401-5112
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Country | US
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Telephone | 207-942-2627
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Fax | 207-942-2627
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Psychologist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PS744
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License Number State | ME
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Taxonomy #3
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Taxonomy Code | 103TC2200X
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Taxonomy Name | Clinical Child & Adolescent Psychologist
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License Number |
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Taxonomy #4
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Taxonomy Code | 103TF0000X
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Taxonomy Name | Family Psychologist
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Taxonomy #5
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Taxonomy Code | 103TF0200X
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Taxonomy Name | Forensic Psychologist
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Taxonomy #6
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Taxonomy Code | 103TP2701X
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Taxonomy Name | Group Psychotherapy Psychologist
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License Number |
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