Provider Demographics
NPI:1730343609
Name:SIEGEL, BARRY JOEL (LADC1)
Entity type:Individual
Prefix:MR
First Name:BARRY
Middle Name:JOEL
Last Name:SIEGEL
Suffix:
Gender:M
Credentials:LADC1
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 EMBANKMENT ST
Mailing Address - Street 2:
Mailing Address - City:LAWRENCE
Mailing Address - State:MA
Mailing Address - Zip Code:01841-4728
Mailing Address - Country:US
Mailing Address - Phone:978-687-6300
Mailing Address - Fax:978-682-4843
Practice Address - Street 1:10 EMBANKMENT ST
Practice Address - Street 2:
Practice Address - City:LAWRENCE
Practice Address - State:MA
Practice Address - Zip Code:01841-4728
Practice Address - Country:US
Practice Address - Phone:978-687-6300
Practice Address - Fax:978-682-4843
Is Sole Proprietor?:No
Enumeration Date:2008-07-10
Last Update Date:2008-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1738101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)