Provider Demographics
NPI:1376793323
Name:SEGAL, SHELLEY L (PSYD)
Entity Type:Individual
Prefix:DR
First Name:SHELLEY
Middle Name:L
Last Name:SEGAL
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16550 VENTURA BLVD STE 405
Mailing Address - Street 2:
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91436-2084
Mailing Address - Country:US
Mailing Address - Phone:818-784-1055
Mailing Address - Fax:
Practice Address - Street 1:16550 VENTURA BLVD STE 405
Practice Address - Street 2:
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91436-2084
Practice Address - Country:US
Practice Address - Phone:818-784-1055
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-26
Last Update Date:2008-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY20040103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical