Provider Demographics
NPI:1013916964
Name:SEGAL, NATHAN JAY (LCSW)
Entity Type:Individual
Prefix:
First Name:NATHAN
Middle Name:JAY
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 1:900 N 6TH ST
Mailing Address - Street 2:
Mailing Address - City:HARRISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17102-1703
Mailing Address - Country:US
Mailing Address - Phone:717-233-4027
Mailing Address - Fax:
Practice Address - Street 1:900 N 6TH ST
Practice Address - Street 2:
Practice Address - City:HARRISBURG
Practice Address - State:PA
Practice Address - Zip Code:17102-1703
Practice Address - Country:US
Practice Address - Phone:717-233-4027
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-07-21
Last Update Date:2011-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0133641041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAS80822Medicare UPIN
PA027467Medicare PIN