Individual
MR. GLEN THOMAS SEGOND
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LCSW
Contact information
Practice address
117 BROAD ST, STROUDSBURG, PA 18360-1534
(570) 424-6049
(570) 424-0917
Mailing address
RR 2 BOX 2205, EAST STROUDSBURG, PA 18301-9639
(570) 424-6049
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
44SC05112500
NJ
1041C0700X
Clinical Social Worker
Primary
CW004643L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5013039
AETNA PROVIDER NUMBER
PA
01
—
SE690000
HIGHMARK BS FED EMPL PROV
PA
Enumeration date
08/31/2006
Last updated
07/08/2007
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