Provider Demographics
NPI:1730175738
Name:SIEGMANN-BEINER, PENNY E (LCSW-R)
Entity type:Individual
Prefix:
First Name:PENNY
Middle Name:E
Last Name:SIEGMANN-BEINER
Suffix:
Gender:F
Credentials:LCSW-R
Other - Prefix:
Other - First Name:PENNY
Other - Middle Name:E
Other - Last Name:SIEGMANN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW-R
Mailing Address - Street 1:54 CHICAGO AVE
Mailing Address - Street 2:
Mailing Address - City:MASSAPEQUA
Mailing Address - State:NY
Mailing Address - Zip Code:11758
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:54 CHICAGO AVE
Practice Address - Street 2:
Practice Address - City:MASSAPEQUA
Practice Address - State:NY
Practice Address - Zip Code:11758
Practice Address - Country:US
Practice Address - Phone:516-528-6712
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-25
Last Update Date:2015-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR053589-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01703777Medicaid
NY01703777Medicaid