Organization
KENNETH A SIEGEL, PH.D., PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KENNETH A SIEGEL PH.D. (PRESIDENT)
(757) 422-9733
Entity
Organization
Contact information
Practice address
933 FIRST COLONIAL RD, SUITE 201, VIRGINIA BEACH, VA 23454-3172
(757) 422-9733
(757) 422-4078
Mailing address
933 FIRST COLONIAL RD, SUITE 201, VIRGINIA BEACH, VA 23454-3172
(757) 422-9733
(757) 422-4078
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
0810000887
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
006215
ANTHEM BLUE CROSS/BLUE SHIELD
VA
01
—
083028
SENTARA
VA
01
—
4107739
AETNA
VA
01
—
620000012
MEDICARE
VA
05
—
7714203
—
VA
Enumeration date
05/01/2008
Last updated
05/01/2008
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