Provider Demographics
NPI:1689732562
Name:SEGEL, MARTIN D (MARTIN SEGEL)
Entity Type:Individual
Prefix:DR
First Name:MARTIN
Middle Name:D
Last Name:SEGEL
Suffix:
Gender:M
Credentials:MARTIN SEGEL
Other - Prefix:DR
Other - First Name:MARTIN
Other - Middle Name:D
Other - Last Name:SEGEL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:9250 GLADES RD
Mailing Address - Street 2:109
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33434-3958
Mailing Address - Country:US
Mailing Address - Phone:561-558-8333
Mailing Address - Fax:561-558-8383
Practice Address - Street 1:9250 GLADES RD
Practice Address - Street 2:109
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33434-3958
Practice Address - Country:US
Practice Address - Phone:561-558-8333
Practice Address - Fax:561-558-8383
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY5564103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL54090Medicare ID - Type UnspecifiedPSYCHOLOGIST