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General NPI Number Information
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NPI Number | 1437575412
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Entity Type | Individual
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Provider Name | MYRON R SIEGEL MSW
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Gender | Male
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Dates
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Enumeration Date | 03/13/2014
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Last Update Date | 03/13/2014
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Provider Practice Location Address
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Address Line | 7345 BURTON AVE
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City | ROHNERT PARK
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State | CA
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Zip | 94928-3396
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Country | US
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Telephone | 707-793-9030
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Fax | 707-793-9234
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Provider Business Mailing Address
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Address Line | 3650 STANDISH AVE
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City | SANTA ROSA
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State | CA
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Zip | 95407-8113
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Country | US
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Telephone | 707-793-9030
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Fax | 707-793-9234
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | ASW 28923
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License Number State | CA
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