Provider Demographics
NPI:1144460072
Name:SEGAL, YOLANDA DORIA (PSYD)
Entity type:Individual
Prefix:DR
First Name:YOLANDA
Middle Name:DORIA
Last Name:SEGAL
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:DR
Other - First Name:YOLANDA
Other - Middle Name:BEATRIZ
Other - Last Name:DORIA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PSYD
Mailing Address - Street 1:PO BOX 481
Mailing Address - Street 2:
Mailing Address - City:VAIL
Mailing Address - State:AZ
Mailing Address - Zip Code:85641-0481
Mailing Address - Country:US
Mailing Address - Phone:202-731-0776
Mailing Address - Fax:
Practice Address - Street 1:10420 S PAINTED MARE DR
Practice Address - Street 2:
Practice Address - City:VAIL
Practice Address - State:AZ
Practice Address - Zip Code:85641-6830
Practice Address - Country:US
Practice Address - Phone:202-731-0776
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-05
Last Update Date:2020-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCPRC14023103TC0700X
AZPSY005247103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical