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General NPI Number Information
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NPI Number | 1629168596
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Entity Type | Individual
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Provider Name | MARY ELIZABETH SIEGEL PHD
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Gender | Female
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Dates
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Enumeration Date | 10/13/2006
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Last Update Date | 12/19/2011
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Provider Practice Location Address
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Address Line | 363 OCEAN DR W
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City | STAMFORD
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State | CT
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Zip | 06902-8222
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Country | US
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Telephone | 203-324-9996
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Fax | 203-921-1565
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Provider Business Mailing Address
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Address Line | 363 OCEAN DR W
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City | STAMFORD
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State | CT
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Zip | 06902-8222
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Country | US
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Telephone | 203-324-9996
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Fax | 203-921-1565
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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 | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 001450
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License Number State | CT
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