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General NPI Number Information
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NPI Number | 1629223490
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Entity Type | Individual
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Provider Name | JEFFREY DONALD SIEMSEN LCSW
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Gender | Male
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Dates
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Enumeration Date | 11/20/2008
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Last Update Date | 09/26/2011
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Provider Practice Location Address
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Address Line | 107 MARSHALL BRIDGE RD
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City | KENNETT SQUARE
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State | PA
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Zip | 19348-2705
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Country | US
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Telephone | 302-521-3019
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Fax | 610-444-0226
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Provider Business Mailing Address
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Address Line | 107 MARSHALL BRIDGE RD
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City | KENNETT SQUARE
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State | PA
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Zip | 19348-2705
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Country | US
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Telephone | 302-521-3019
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Fax | 610-444-0226
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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 | CW016873
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License Number State | PA
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