Provider Demographics
NPI:1629060173
Name:SEGAL, STUART S (PHD)
Entity Type:Individual
Prefix:
First Name:STUART
Middle Name:S
Last Name:SEGAL
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28800 ORCHARD LAKE RD
Mailing Address - Street 2:SUITE 250
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48334-2981
Mailing Address - Country:US
Mailing Address - Phone:248-932-2500
Mailing Address - Fax:248-932-2506
Practice Address - Street 1:28800 ORCHARD LAKE RD
Practice Address - Street 2:SUITE 250
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48334-2981
Practice Address - Country:US
Practice Address - Phone:248-932-2500
Practice Address - Fax:248-932-2506
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301007428103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0M39900Medicare ID - Type Unspecified
MIS40953Medicare UPIN