Provider Demographics
NPI:1093291007
Name:SEGAL, KIMBERLY SHANA
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:SHANA
Last Name:SEGAL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:76 SUMMER ST
Mailing Address - Street 2:
Mailing Address - City:HAVERHILL
Mailing Address - State:MA
Mailing Address - Zip Code:01830-5814
Mailing Address - Country:US
Mailing Address - Phone:978-556-8222
Mailing Address - Fax:
Practice Address - Street 1:76 SUMMER ST
Practice Address - Street 2:
Practice Address - City:HAVERHILL
Practice Address - State:MA
Practice Address - Zip Code:01830-5814
Practice Address - Country:US
Practice Address - Phone:978-556-8222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-12
Last Update Date:2018-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1111401041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical