| Doctor Name: | MR. MARK IAN SEGAL |
| NPI Number: | 1154591527 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | LCSW-C |
| License Number: | 11838 |
| Business Practice Address: | 931 Truro Ln Crofton, MD - 211141203 |
| Business Phone Number: | 4432924164 |
| Business Fax Number: | |
| Mailing Address: | 931 Truro Ln, CROFTON |
| State: | MD |
| Postal Code: | 211141203 |
| Phone Number: | 4432924164 |
| Fax Number: | |
| NPI Enumeration Date: | 03/02/2008 |
| NPI Last Update Date: | 11/09/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 1041C0700X |
| License Number: | 11838 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MD |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Social Worker |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | A social worker who holds a master |