Individual
DR. THEODORE SIEDLECKI JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PH.D.
Contact information
Practice address
233 HYDRAULIC RIDGE RD, STE 204, CHARLOTTESVILLE, VA 22901-8129
(434) 973-2526
(434) 975-5948
Mailing address
233 HYDRAULIC RIDGE RD STE 204, CHARLOTTESVILLE, VA 22901-8129
(434) 973-2526
(434) 975-5948
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
0810001918
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
007707703
—
VA
Enumeration date
09/14/2005
Last updated
04/19/2012
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