Organization
ETHAN SIEGEL, PSY.D.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ETHAN ROBERT SIEGEL PSY.D. (PSYCHOLOGIST)
(703) 819-6177
Entity
Organization
Contact information
Practice address
6400 SEVEN CORNERS PL, SUITE R, FALLS CHURCH, VA 22044-2009
(703) 819-6177
Mailing address
6400 SEVEN CORNERS PL, SUITE R, FALLS CHURCH, VA 22044-2009
(703) 819-6177
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
0810004627
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1043568975
TYPE 1 NPI
VA
Enumeration date
10/18/2016
Last updated
10/18/2016
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