Provider Demographics
NPI:1043632144
Name:SEGUINOT, ELIZABETH CHEYENNE (MS, MHC)
Entity Type:Individual
Prefix:MS
First Name:ELIZABETH
Middle Name:CHEYENNE
Last Name:SEGUINOT
Suffix:
Gender:F
Credentials:MS, MHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:60 ACADEMY RD
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12214-8037
Mailing Address - Country:US
Mailing Address - Phone:518-431-1658
Mailing Address - Fax:518-447-0429
Practice Address - Street 1:102 HACKETT BLVD.
Practice Address - Street 2:CHILD GUIDANCE CENTER
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12209
Practice Address - Country:US
Practice Address - Phone:518-431-1650
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-01-09
Last Update Date:2014-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYP87339101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY555793Medicaid
NY555793Medicaid