Provider Demographics
NPI:1245529296
Name:SEGAL TELEPSYCHIATRY NETWORK
Entity type:Organization
Organization Name:SEGAL TELEPSYCHIATRY NETWORK
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:OLGA
Authorized Official - Middle Name:
Authorized Official - Last Name:SEGAL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:707-205-7566
Mailing Address - Street 1:655 REDWOOD HWY FRONTAGE RD
Mailing Address - Street 2:SUITE 240
Mailing Address - City:MILL VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:94941-3034
Mailing Address - Country:US
Mailing Address - Phone:866-247-4292
Mailing Address - Fax:866-247-4293
Practice Address - Street 1:655 REDWOOD HWY FRONTAGE RD
Practice Address - Street 2:SUITE 240
Practice Address - City:MILL VALLEY
Practice Address - State:CA
Practice Address - Zip Code:94941-3034
Practice Address - Country:US
Practice Address - Phone:866-247-4292
Practice Address - Fax:866-247-4293
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-30
Last Update Date:2011-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA85774102L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes102L00000XBehavioral Health & Social Service ProvidersPsychoanalystGroup - Single Specialty