Provider Demographics
NPI:1215593405
Name:SEGALL, MORDECHAI (RBT)
Entity Type:Individual
Prefix:
First Name:MORDECHAI
Middle Name:
Last Name:SEGALL
Suffix:
Gender:M
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1164 98TH ST
Mailing Address - Street 2:
Mailing Address - City:BAY HARBOR ISLANDS
Mailing Address - State:FL
Mailing Address - Zip Code:33154-1717
Mailing Address - Country:US
Mailing Address - Phone:702-635-5788
Mailing Address - Fax:
Practice Address - Street 1:1164 98TH ST
Practice Address - Street 2:
Practice Address - City:BAY HARBOR ISLANDS
Practice Address - State:FL
Practice Address - Zip Code:33154-1717
Practice Address - Country:US
Practice Address - Phone:702-635-5788
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-14
Last Update Date:2019-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician