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NPI Code Detail

MEDICARE: MR. NORMAN JESSE SEGAL LICSW

MEDICARE:  MR. NORMAN JESSE SEGAL  LICSW
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
11041C0700XClinical Social Worker1655MN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
15H495SEOTHERMNBLUE CROSS BLUE SHIELD MN

General Provider Information

NPI Number : 1164616942
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. NORMAN JESSE SEGAL LICSW
Provider Business Mailing Address
First Line : 1337 ST CLAIR AV
Second Line : SUITE #1
City : ST PAUL
State : MN
Zip : 55105-2844
Country : US
Telephone Number : 651-698-8053
Fax Number :
Provider Business Practice Location Address
First Line : 1337 ST CLAIR AV
Second Line : SUITE #1
City : ST PAUL
State : MN
Zip : 55105-2844
Country : US
Telephone Number : 651-698-8053
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/05/2007
Last Update Date : 09/05/2007

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Directions to “ MR. NORMAN JESSE SEGAL LICSW” Practice Location

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