MEDICARE: MS. HOLLY BETH SEGAL M.S.W.

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	104100000X	Social Worker	12012	MD
2	1041C0700X	Clinical Social Worker	LC50077901	DC

General Provider Information

NPI Number	:	1205111895
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. HOLLY BETH SEGAL M.S.W.

Provider Business Mailing Address
First Line	:	8500 EXECUTIVE PARK AVE # SUOTE200
Second Line	:
City	:	FAIRFAX
State	:	VA
Zip	:	22031-2225
Country	:	US
Telephone Number	:	703-698-5220
Fax Number	:	703-572-2351

Provider Business Practice Location Address
First Line	:	8500 EXECUTIVE PARK AVE STE 200
Second Line	:
City	:	FAIRFAX
State	:	VA
Zip	:	22031-2228
Country	:	US
Telephone Number	:	703-698-5220
Fax Number	:	703-572-2351

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

Provider Enumeration Date	:	10/15/2011
Last Update Date	:	06/14/2023

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