Provider Demographics
NPI:1639143159
Name:SEGAL, BURTON ALAN (LCSW)
Entity Type:Individual
Prefix:
First Name:BURTON
Middle Name:ALAN
Last Name:SEGAL
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 KINGSLEY LN
Mailing Address - Street 2:SUITE 401
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23505-4614
Mailing Address - Country:US
Mailing Address - Phone:757-489-4700
Mailing Address - Fax:757-489-0240
Practice Address - Street 1:110 KINGSLEY LN
Practice Address - Street 2:SUITE 401
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23505-4614
Practice Address - Country:US
Practice Address - Phone:757-489-4700
Practice Address - Fax:757-489-0240
Is Sole Proprietor?:No
Enumeration Date:2006-02-13
Last Update Date:2010-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040007911041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA8901015Medicaid
VA800000237Medicare ID - Type Unspecified