Provider Demographics
NPI:1376318691
Name:SEGALINE, KELLY ANN (MS ATR-BC LPC)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:ANN
Last Name:SEGALINE
Suffix:
Gender:F
Credentials:MS ATR-BC LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:528 WALNUT AVE
Mailing Address - Street 2:
Mailing Address - City:BENSALEM
Mailing Address - State:PA
Mailing Address - Zip Code:19020-7070
Mailing Address - Country:US
Mailing Address - Phone:267-516-5080
Mailing Address - Fax:
Practice Address - Street 1:528 WALNUT AVE
Practice Address - Street 2:
Practice Address - City:BENSALEM
Practice Address - State:PA
Practice Address - Zip Code:19020-7070
Practice Address - Country:US
Practice Address - Phone:215-821-7757
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-16
Last Update Date:2024-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC16356101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional