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General NPI Number Information
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NPI Number | 1306064753
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Entity Type | Organization
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Legal Business Name | ELEANOR A SIEGEL
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Dates
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Enumeration Date | 04/23/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 495 IRON BRIDGE RD SUITE 8
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City | FREEHOLD
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State | NJ
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Zip | 07728-3069
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Country | US
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Telephone | 732-294-9694
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Fax | 732-294-7470
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Provider Business Mailing Address
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Address Line | 495 IRON BRIDGE RD SUITE 8
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City | FREEHOLD
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State | NJ
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Zip | 07728-3069
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Country | US
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Telephone | 732-294-9694
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Fax | 732-294-7470
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Authorized Official
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Title or Position | OWNER
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Name | ELEANOR A SIEGEL
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Credential | PHD
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Telephone | 732-294-9694
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 35SI00107300
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License Number State | NJ
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