Provider Demographics
NPI:1043678212
Name:SEGAL, ADINA MIRIAM (LCSW)
Entity Type:Individual
Prefix:
First Name:ADINA
Middle Name:MIRIAM
Last Name:SEGAL
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:ADINA
Other - Middle Name:MIRIAM
Other - Last Name:SEGAL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:2472 E 28TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11235-1910
Mailing Address - Country:US
Mailing Address - Phone:917-346-7355
Mailing Address - Fax:
Practice Address - Street 1:2472 E 28TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235-1910
Practice Address - Country:US
Practice Address - Phone:917-346-7355
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-03
Last Update Date:2017-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY078887-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical