| Amy Siegel Licsw Llc | |
|
86 Lake St Burlington VT 05401-5297 | |
| (802) 865-3450 | |
| (802) 860-5011 |
| Full Name | Amy Siegel Licsw Llc |
|---|---|
| Speciality | Social Worker |
| Location | 86 Lake St, Burlington, Vermont |
| Authorized Official Name and Position | Amy Siegel (OWNER) |
| Authorized Official Contact | 8028653450 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Amy Siegel Licsw Llc 86 Lake St Burlington VT 05401-5297 Ph: (802) 865-3450 | Amy Siegel Licsw Llc 86 Lake St Burlington VT 05401-5297 Ph: (802) 865-3450 |
| NPI Number | 1821515685 |
|---|---|
| Provider Enumeration Date | 08/23/2017 |
| Last Update Date | 07/21/2022 |
| Medicare PECOS PAC ID | 1850664491 |
|---|---|
| Medicare Enrollment ID | O20170905000041 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1821515685 | NPI | - | NPPES |
| 1013883 | Medicaid | VT |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | 089-0001188 (Vermont) | Primary |
| Provider Name | Amy S Siegel |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1225237605 PECOS PAC ID: 4587735097 Enrollment ID: I20080611000173 |
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