Basic Information
| Provider Information | |||||||||
| NPI: | 1407127301 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SIEGEL | ||||||||
| FirstName: | SETH | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1328 SECOND STREET | ||||||||
| Address2: | |||||||||
| City: | SANTA MONICA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 90401 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3105761308 | ||||||||
| FaxNumber: | 9074636858 | ||||||||
| Practice Location | |||||||||
| Address1: | 3435 OCEAN PARK BLVD #207 | ||||||||
| Address2: | |||||||||
| City: | SANTA MONICA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 90405 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3103929474 | ||||||||
| FaxNumber: | 9074636858 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/24/2012 | ||||||||
| LastUpdateDate: | 09/09/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.