Provider Demographics
NPI:1265581607
Name:SIEK, BETH DORANNE (PSYD)
Entity type:Individual
Prefix:DR
First Name:BETH
Middle Name:DORANNE
Last Name:SIEK
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:12108 N 56TH ST
Mailing Address - Street 2:SUITE F
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33617-1686
Mailing Address - Country:US
Mailing Address - Phone:813-988-6557
Mailing Address - Fax:813-931-1683
Practice Address - Street 1:12108 N 56TH ST
Practice Address - Street 2:SUITE F
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33617-1686
Practice Address - Country:US
Practice Address - Phone:813-988-6557
Practice Address - Fax:813-931-1683
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-08
Last Update Date:2008-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY0005435103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL59872Medicare PIN