Basic Information
| Provider Information | |||||||||
| NPI: | 1700149879 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SIEGEL | ||||||||
| FirstName: | REBECCA | ||||||||
| MiddleName: | SAVOY | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | PH.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 776351 | ||||||||
| Address2: | |||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606776351 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5025889490 | ||||||||
| FaxNumber: | 5022725116 | ||||||||
| Practice Location | |||||||||
| Address1: | 4123 DUTCHMANS LANE | ||||||||
| Address2: | SUITE 307 | ||||||||
| City: | LOUISVILLE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 402074721 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5024095600 | ||||||||
| FaxNumber: | 5022593078 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/22/2012 | ||||||||
| LastUpdateDate: | 01/21/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 01/21/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103TC0700X | 4334 | NC | N | Behavioral Health & Social Service Providers | Psychologist | Clinical | 103TC2200X | 4334 | NC | N | Behavioral Health & Social Service Providers | Psychologist | Clinical Child & Adolescent | 103TC0700X | PSYLIP00211362 | KY | Y | Behavioral Health & Social Service Providers | Psychologist | Clinical |
ID Information
| ID | Type | State | Issuer | Description | 7100387330 | 05 | KY | MEDICAID | 000000973218 | 01 | KY | ANTHEM | OTHER | 208486 | 01 | KY | SIHO | OTHER | 50102071 | 01 | KY | PASSPORT | OTHER |