Provider Demographics
NPI:1205074671
Name:SEGAL,, JAMES S (MSW, LCSW)
Entity type:Individual
Prefix:MR
First Name:JAMES
Middle Name:S
Last Name:SEGAL,
Suffix:
Gender:M
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6212 LATCHSTRING RD
Mailing Address - Street 2:
Mailing Address - City:MELROSE
Mailing Address - State:FL
Mailing Address - Zip Code:32666-6138
Mailing Address - Country:US
Mailing Address - Phone:352-475-3100
Mailing Address - Fax:305-359-5111
Practice Address - Street 1:1505 NW 16TH AVE
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32605-4036
Practice Address - Country:US
Practice Address - Phone:352-475-1956
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-23
Last Update Date:2009-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL7021041C0700X
FL532106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist