Provider Demographics
NPI:1801412150
Name:SEGALL, ZACHARY A (AMFT)
Entity type:Individual
Prefix:MR
First Name:ZACHARY
Middle Name:A
Last Name:SEGALL
Suffix:
Gender:M
Credentials:AMFT
Other - Prefix:
Other - First Name:ZACK
Other - Middle Name:
Other - Last Name:SEGALL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:ZACK
Mailing Address - Street 1:621 NATOMA ST
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94103-2719
Mailing Address - Country:US
Mailing Address - Phone:954-665-3222
Mailing Address - Fax:
Practice Address - Street 1:1801 VICENTE ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94116-2923
Practice Address - Country:US
Practice Address - Phone:317-541-5682
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-23
Last Update Date:2021-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106H00000X
CAAMFT126487106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist