Theodore Siedlecki Jr., PH.D.

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

0810001918 Issued in VA

Practice address

233 Hydraulic Ridge Rd
Ste 204
Charlottesville, VA 22901-8129

Phone

(434) 973-2526

Fax

(434) 975-5948

NPI assigned

Sep 14, 2005

Last updated

Apr 19, 2012By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Ruth M Ball PHD LLC

  • Adult Mental Health Clinic/Center
  • Charlottesville, VA
  • NPI 1306410899
  NPD (past)

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

{
    "created_epoch": "1126656000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1334793600000",
    "number": "1952396012",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "233 HYDRAULIC RIDGE RD STE 204",
            "city": "CHARLOTTESVILLE",
            "state": "VA",
            "postal_code": "229018129",
            "telephone_number": "434-973-2526",
            "fax_number": "434-975-5948"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "233 HYDRAULIC RIDGE RD",
            "address_2": "STE 204",
            "city": "CHARLOTTESVILLE",
            "state": "VA",
            "postal_code": "229018129",
            "telephone_number": "434-973-2526",
            "fax_number": "434-975-5948"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SIEDLECKI",
        "first_name": "THEODORE",
        "name_prefix": "Dr.",
        "name_suffix": "Jr.",
        "credential": "PH.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-09-14",
        "last_updated": "2012-04-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "VA",
            "license": "0810001918",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "007707703",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Dianna Sicilia
• Kelly Anne Sicoli, CNM
• Mohammad S Siddiqui, MD
• Rasheed A Siddiqui, MD
• Edward Waters Sidebottom, LPC
• Madeline Sieglinger, PA
• Angela M Sieminski
• Daniel B Sieminski
• Jenny Lynne Siepka, RN
• Salvador Sierra, MD, PHD

• Clinical Psychologist in Charlottesville, VA
• Providers in Charlottesville, VA by specialty
• Clinical Psychologist in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 19, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.