Provider Demographics
NPI:1396814406
Name:SEGAL, MADELINE HILARY (LICSW)
Entity Type:Individual
Prefix:MS
First Name:MADELINE
Middle Name:HILARY
Last Name:SEGAL
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 SUMNER ST
Mailing Address - Street 2:
Mailing Address - City:SWAMPSCOTT
Mailing Address - State:MA
Mailing Address - Zip Code:01907-1449
Mailing Address - Country:US
Mailing Address - Phone:781-595-8265
Mailing Address - Fax:978-745-2804
Practice Address - Street 1:6 NORMAN ST
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:MA
Practice Address - Zip Code:01970-3314
Practice Address - Country:US
Practice Address - Phone:978-745-5114
Practice Address - Fax:978-745-2804
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1008121041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1891481Medicaid
MA1891481Medicaid