Provider Demographics
NPI:1902801772
Name:SEGALL, SETH ROBERT (PHD)
Entity Type:Individual
Prefix:DR
First Name:SETH
Middle Name:ROBERT
Last Name:SEGALL
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1130 NOTCH RD
Mailing Address - Street 2:
Mailing Address - City:CHESHIRE
Mailing Address - State:CT
Mailing Address - Zip Code:06410-1915
Mailing Address - Country:US
Mailing Address - Phone:203-272-0129
Mailing Address - Fax:
Practice Address - Street 1:850 STRAITS TPKE
Practice Address - Street 2:STE 204
Practice Address - City:MIDDLEBURY
Practice Address - State:CT
Practice Address - Zip Code:06762-2843
Practice Address - Country:US
Practice Address - Phone:203-758-2867
Practice Address - Fax:203-758-2708
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT948103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical