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NPI Code Detail

MEDICARE: MR. JON DAVID SIEGEL LCSW

MEDICARE: MR. JON DAVID SIEGEL LCSW
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103TA0700XAdult Development & Aging PsychologistSW 0283IAZ
2103T00000XPsychologistSW 0283IAZ
31041C0700XClinical Social WorkerSW 0283IAZ

General Provider Information

NPI Number : 1518984095
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. JON DAVID SIEGEL LCSW
Provider Business Mailing Address
First Line : PO BOX 82425
Second Line :
City : PHOENIX
State : AZ
Zip : 85071-2425
Country : US
Telephone Number : 602-993-7220
Fax Number : 602-993-3200
Provider Business Practice Location Address
First Line : 4232 N BROWN AVE
Second Line : SUITE 4
City : SCOTTSDALE
State : AZ
Zip : 85251-3996
Country : US
Telephone Number : 602-993-7220
Fax Number : 602-993-3200
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/17/2006
Last Update Date : 09/11/2025

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