Provider Demographics
NPI:1124760558
Name:SEGAL, LAURIE ANN (MSW)
Entity type:Individual
Prefix:MS
First Name:LAURIE
Middle Name:ANN
Last Name:SEGAL
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:LAURIE
Other - Middle Name:ANN
Other - Last Name:SEGAL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MSW
Mailing Address - Street 1:322 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:PORT WASHINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:11050-2738
Mailing Address - Country:US
Mailing Address - Phone:516-353-2298
Mailing Address - Fax:516-944-1700
Practice Address - Street 1:322 MAIN ST
Practice Address - Street 2:
Practice Address - City:PORT WASHINGTON
Practice Address - State:NY
Practice Address - Zip Code:11050-2738
Practice Address - Country:US
Practice Address - Phone:516-353-2298
Practice Address - Fax:516-944-1700
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-07
Last Update Date:2022-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0373871041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical