Provider Demographics
NPI:1427114016
Name:SEGERSTEN, MARIE E (LICSW)
Entity type:Individual
Prefix:
First Name:MARIE
Middle Name:E
Last Name:SEGERSTEN
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:923 ROUTE 6A UNIT N
Mailing Address - Street 2:
Mailing Address - City:YARMOUTH PORT
Mailing Address - State:MA
Mailing Address - Zip Code:02675-2159
Mailing Address - Country:US
Mailing Address - Phone:508-362-4250
Mailing Address - Fax:
Practice Address - Street 1:923 ROUTE 6A UNIT N
Practice Address - Street 2:
Practice Address - City:YARMOUTH PORT
Practice Address - State:MA
Practice Address - Zip Code:02675-2159
Practice Address - Country:US
Practice Address - Phone:508-362-4250
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1052471041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA467532OtherTUFTS HEALTH PLAN ID
MAP08271OtherBCBS OF MA ID
MAP08271OtherBCBS OF MA ID