=====================================================
General NPI Number Information
=====================================================
NPI Number | 1225330319
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HEIDI H SIEBERT, LMFT, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/23/2010
-----------------------------------------------------
Last Update Date | 11/23/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5 EVERSLEY AVE 3RD FLOOR
-----------------------------------------------------
City | NORWALK
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06851-5821
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 203-829-4196
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2490 BLACK ROCK TPKE #341
-----------------------------------------------------
City | FAIRFIELD
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06825-2400
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 203-829-4196
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/PSYCHOTHERAPIST
-----------------------------------------------------
Name | MS. HEIDI HENDERSON SIEBERT
-----------------------------------------------------
Credential | LMFT
-----------------------------------------------------
Telephone | 203-829-4196
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 106H00000X
-----------------------------------------------------
Taxonomy Name | Marriage & Family Therapist
-----------------------------------------------------
License Number | 1250
-----------------------------------------------------
License Number State | CT
-----------------------------------------------------