Healthcare Provider Details

I. General information

NPI: 1891974317
Provider Name (Legal Business Name): MARTIN D SEGEL PH.D.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/31/2007
Last Update Date: 07/17/2024
Certification Date: 07/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4851 W HILLSBORO BLVD A1
COCONUT CREEK FL
33073-4355
US

IV. Provider business mailing address

4851 W HILLSBORO BLVD A1
COCONUT CREEK FL
33073-4355
US

V. Phone/Fax

Practice location:
  • Phone: 954-428-6020
  • Fax: 954-428-6022
Mailing address:
  • Phone: 954-428-6020
  • Fax: 954-428-6022

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPY5564
License Number StateFL

VIII. Authorized Official

Name: DR. MARTIN D SEGEL
Title or Position: PSYCHOLOGIST
Credential: PHD
Phone: 954-428-6020