Provider Demographics
NPI:1437336062
Name:SEGAL, LAURA SPITZ (MSW)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:SPITZ
Last Name:SEGAL
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24230 RADCLIFT ST
Mailing Address - Street 2:
Mailing Address - City:OAK PARK
Mailing Address - State:MI
Mailing Address - Zip Code:48237-1534
Mailing Address - Country:US
Mailing Address - Phone:248-613-4659
Mailing Address - Fax:734-254-8795
Practice Address - Street 1:199 N MAIN ST
Practice Address - Street 2:SUITE 202
Practice Address - City:PLYMOUTH
Practice Address - State:MI
Practice Address - Zip Code:48170-1272
Practice Address - Country:US
Practice Address - Phone:248-613-4659
Practice Address - Fax:734-254-8795
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-25
Last Update Date:2008-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801014384104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker