Organization Active NPI

Live Fully Trauma Therapy LLC

  • Clinical Social Worker
  • Allentown, PA
National Provider Identifier
1831963701
Registry record updated Oct 26, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
Legal business name
LIVE FULLY TRAUMA THERAPY LLC
Practice address
2200 Hamilton St Ste 325
Allentown, PA 18104-6329
Phone
(484) 706-9832
NPI assigned
Nov 13, 2023
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 26, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Michele Siegfried, LCSWNPI 1285125237
Title
Therapist
Phone
(484) 706-9832

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social WorkerGroup: 193400000X SINGLE SPECIALTY GROUP 1041C0700X Primary

Addresses

Primary practice location

2200 Hamilton St Ste 325
Allentown, PA 18104-6329

Mailing address

2200 Hamilton St
Allentown, PA 18104-6337
Phone (484) 706-9832

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20240110004324 PA Part B Supplier - Clinic/Group Practice 5496106726 Receives reassigned benefits from 1 practitioner
Practice locations: Allentown, PA

National Provider Directory

National Provider Directory

Locations

2200 Hamilton St
Allentown, PA 18104
Phone (610) 433-7481

2200 Hamilton St
Ste 325
Allentown, PA 18104
Phone (484) 519-0122

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1699833600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1729900800000",
    "number": "1831963701",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2200 HAMILTON ST",
            "city": "ALLENTOWN",
            "state": "PA",
            "postal_code": "181046337",
            "telephone_number": "484-706-9832"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2200 HAMILTON ST STE 325",
            "city": "ALLENTOWN",
            "state": "PA",
            "postal_code": "181046329",
            "telephone_number": "484-706-9832"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIVE FULLY TRAUMA THERAPY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-11-13",
        "last_updated": "2024-10-26",
        "certification_date": "2024-10-26",
        "status": "A",
        "authorized_official_last_name": "SIEGFRIED",
        "authorized_official_first_name": "MICHELE",
        "authorized_official_title_or_position": "THERAPIST",
        "authorized_official_telephone_number": "484-706-9832",
        "authorized_official_credential": "LCSW"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Allentown, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 26, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.