Provider Demographics
NPI:1629060173
Name:SEGAL, STUART S (PHD)
Entity type:Individual
Prefix:
First Name:STUART
Middle Name:S
Last Name:SEGAL
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:995 N PONTIAC TRL
Mailing Address - Street 2:
Mailing Address - City:WALLED LAKE
Mailing Address - State:MI
Mailing Address - Zip Code:48390-7055
Mailing Address - Country:US
Mailing Address - Phone:248-539-0200
Mailing Address - Fax:248-539-0987
Practice Address - Street 1:36550 SUNNYDALE ST
Practice Address - Street 2:
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48154-1725
Practice Address - Country:US
Practice Address - Phone:248-539-0200
Practice Address - Fax:248-539-0987
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-19
Last Update Date:2025-09-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI6301007428103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0M39900Medicare ID - Type Unspecified
MIS40953Medicare UPIN