MEDICARE: TRACEY SEGAL

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	MH22112	FL

General Provider Information

NPI Number	:	1144917055
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TRACEY SEGAL

Provider Business Mailing Address
First Line	:	16330 CASTELLO CT
Second Line	:
City	:	DELRAY BEACH
State	:	FL
Zip	:	33484-6494
Country	:	US
Telephone Number	:	516-639-8488
Fax Number	:

Provider Business Practice Location Address
First Line	:	16330 CASTELLO CT
Second Line	:
City	:	DELRAY BEACH
State	:	FL
Zip	:	33484-6494
Country	:	US
Telephone Number	:	561-639-8488
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/20/2023
Last Update Date	:	04/20/2023

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Directions to “ TRACEY SEGAL ” Practice Location

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