Siedlecki, Theodore
Siedlecki, Theodore is an sole proprietor health care provider with primary practice located at 233 Hydraulic Ridge Rd Ste 204, Charlottesville VA 22901-8129. He recently has only one registered license in Behavioral Health & Social Service Providers / Clinical, which is considered as his primary health care specialty. Siedlecki, Theodore can be contacted via phone (434) 973-2526.Contact Information
Primary practice address
233 Hydraulic Ridge Rd Ste 204
Charlottesville VA 22901-8129
Phone: (434) 973-2526
Fax: (434) 975-5948
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Behavioral Health & Social Service Providers / Clinical | 103TC0700X | 0810001918 | Virginia |
Profile Details
| NPI number | 1952396012 |
|---|---|
| LBN Legal business name | Siedlecki, Theodore |
| Credentials | PH.D. |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Sep 14th, 2005 |
| Last updated | Apr 19th, 2012 - about 12 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1952396012 | NPPES |
| Virginia | MEDICAID | 007707703 |
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