Provider Demographics
NPI:1437483948
Name:SEGAL, LIAT (ACSW)
Entity Type:Individual
Prefix:
First Name:LIAT
Middle Name:
Last Name:SEGAL
Suffix:
Gender:F
Credentials:ACSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3919 4TH AVE STE B
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92103-3172
Mailing Address - Country:US
Mailing Address - Phone:619-231-2668
Mailing Address - Fax:619-231-4133
Practice Address - Street 1:3919 4TH AVE STE B
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92103-3172
Practice Address - Country:US
Practice Address - Phone:619-231-2668
Practice Address - Fax:619-231-4133
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-30
Last Update Date:2009-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA200851041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical