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General NPI Number Information
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NPI Number | 1902451230
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Entity Type | Individual
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Provider Name | ENEDINA SEGURA LCSW-C
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Gender | Female
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Dates
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Enumeration Date | 08/05/2019
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Last Update Date | 10/20/2025
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Provider Practice Location Address
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Address Line | 125 DIAMOND CT
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City | SHILOH
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State | IL
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Zip | 62269-3617
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Country | US
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Telephone | 618-632-7434
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Fax |
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Provider Business Mailing Address
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Address Line | 322 LIMERICK LN
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City | BELLEVILLE
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State | IL
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Zip | 62221-3501
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 149.030457
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | 21616
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License Number State | MD
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