Provider Demographics
NPI:1154517936
Name:SEGAL, ABBY B (MSW)
Entity type:Individual
Prefix:
First Name:ABBY
Middle Name:B
Last Name:SEGAL
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4599 WALNUT LAKE RD
Mailing Address - Street 2:SEGAL
Mailing Address - City:BLOOMFIELD HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48301-1403
Mailing Address - Country:US
Mailing Address - Phone:215-280-6144
Mailing Address - Fax:
Practice Address - Street 1:4599 WALNUT LAKE RD
Practice Address - Street 2:
Practice Address - City:BLOOMFIELD HILLS
Practice Address - State:MI
Practice Address - Zip Code:48301-1403
Practice Address - Country:US
Practice Address - Phone:215-280-6144
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-09-14
Last Update Date:2022-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0139991041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1000008810009Medicaid
PA1000008810025OtherPA WELFARE
PA663348Medicare UPIN