Provider Demographics
NPI:1689732562
Name:SEGEL, MARTIN D (MARTIN SEGEL)
Entity type:Individual
Prefix:DR
First Name:MARTIN
Middle Name:D
Last Name:SEGEL
Suffix:
Gender:M
Credentials:MARTIN SEGEL
Other - Prefix:DR
Other - First Name:MARTIN
Other - Middle Name:D
Other - Last Name:SEGEL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:4851 W HILLSBORO BLVD STE A1
Mailing Address - Street 2:
Mailing Address - City:COCONUT CREEK
Mailing Address - State:FL
Mailing Address - Zip Code:33073-4355
Mailing Address - Country:US
Mailing Address - Phone:954-428-6020
Mailing Address - Fax:954-428-6022
Practice Address - Street 1:4851 W HILLSBORO BLVD STE A1
Practice Address - Street 2:
Practice Address - City:COCONUT CREEK
Practice Address - State:FL
Practice Address - Zip Code:33073-4355
Practice Address - Country:US
Practice Address - Phone:954-428-6020
Practice Address - Fax:954-428-6022
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-05
Last Update Date:2024-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY5564103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL54090Medicare ID - Type UnspecifiedPSYCHOLOGIST