Provider Demographics
NPI:1508080854
Name:SEGALA, NANCY JEAN (LCSW)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:JEAN
Last Name:SEGALA
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:817 JOLANDA CIR
Mailing Address - Street 2:
Mailing Address - City:VENICE
Mailing Address - State:FL
Mailing Address - Zip Code:34285-4441
Mailing Address - Country:US
Mailing Address - Phone:941-488-5457
Mailing Address - Fax:
Practice Address - Street 1:12497 S. TAMIAMI TRAIL
Practice Address - Street 2:# 9
Practice Address - City:NORTHPORT
Practice Address - State:FL
Practice Address - Zip Code:34287-1419
Practice Address - Country:US
Practice Address - Phone:941-429-0804
Practice Address - Fax:941-429-0814
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW 81751041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical