Healthcare Provider Details

I. General information

NPI: 1740115765
Provider Name (Legal Business Name): SKYLER SEGAL LSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/13/2026
Last Update Date: 06/13/2026
Certification Date: 06/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28 HIGHFIELD LN
NUTLEY NJ
07110-1929
US

IV. Provider business mailing address

28 HIGHFIELD LN
NUTLEY NJ
07110-1929
US

V. Phone/Fax

Practice location:
  • Phone: 973-803-1440
  • Fax:
Mailing address:
  • Phone: 973-803-1440
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number44SL07467300
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: