Provider Demographics
NPI:1477364131
Name:STUART S. SEGAL, PH.D., PLLC
Entity type:Organization
Organization Name:STUART S. SEGAL, PH.D., PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JEFF
Authorized Official - Middle Name:
Authorized Official - Last Name:PERRY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-539-0200
Mailing Address - Street 1:2619 KINGSTOWNE DR
Mailing Address - Street 2:
Mailing Address - City:COMMERCE TWP
Mailing Address - State:MI
Mailing Address - Zip Code:48390-2712
Mailing Address - Country:US
Mailing Address - Phone:248-539-0200
Mailing Address - Fax:
Practice Address - Street 1:6346 ORCHARD LAKE RD STE 200
Practice Address - Street 2:
Practice Address - City:WEST BLOOMFIELD
Practice Address - State:MI
Practice Address - Zip Code:48322-2330
Practice Address - Country:US
Practice Address - Phone:248-539-0200
Practice Address - Fax:248-539-0987
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-01-14
Last Update Date:2025-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty