Provider Demographics
NPI:1376851675
Name:SEGUEL, ANDREW E (MS, LPC, LCMHC)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:E
Last Name:SEGUEL
Suffix:
Gender:M
Credentials:MS, LPC, LCMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 PINNACLE RDG
Mailing Address - Street 2:
Mailing Address - City:UNDERHILL
Mailing Address - State:VT
Mailing Address - Zip Code:05489-4411
Mailing Address - Country:US
Mailing Address - Phone:973-980-5123
Mailing Address - Fax:
Practice Address - Street 1:22 PINNACLE RDG
Practice Address - Street 2:
Practice Address - City:UNDERHILL
Practice Address - State:VT
Practice Address - Zip Code:05489-4411
Practice Address - Country:US
Practice Address - Phone:318-523-0523
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-21
Last Update Date:2023-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00611600101Y00000X, 101YM0800X, 101YP2500X
VT068.0134602101Y00000X, 101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ527486OtherAGENCY PROVIDER NUMBER
NJ0023701OtherAGENCY PROVIDER NUMBER
NJ7794703OtherAGENCY PROVIDER NUMBER FOR PROGRAM