Basic Information
Provider Information
NPI: 1003008335
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: SIEGEL HAUSMAN
FirstName: LORI
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: PHD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName: SIEGEL
OtherFirstName: LORI
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential: PHD
OtherLastNameType: 5
Mailing Information
Address1: 4 ALLEGHENY CTR FL 8
Address2:  
City: PITTSBURGH
State: PA
PostalCode: 152125255
CountryCode: US
TelephoneNumber: 4123304000
FaxNumber: 4123304366
Practice Location
Address1: 4 ALLEGHENY CTR FL 8
Address2:  
City: PITTSBURGH
State: PA
PostalCode: 152125255
CountryCode: US
TelephoneNumber: 4123304000
FaxNumber: 4123304366
Other Information
ProviderEnumerationDate: 08/10/2007
LastUpdateDate: 01/16/2017
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
103TC0700XPS017455PAY Behavioral Health & Social Service ProvidersPsychologistClinical

ID Information
IDTypeStateIssuerDescription
10288872005PA MEDICAID


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