Provider Demographics
NPI:1467715961
Name:SEGARRA, JUDITH (MS ED SBL)
Entity Type:Individual
Prefix:MS
First Name:JUDITH
Middle Name:
Last Name:SEGARRA
Suffix:
Gender:F
Credentials:MS ED SBL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41 W 112TH ST
Mailing Address - Street 2:3J
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10026-3915
Mailing Address - Country:US
Mailing Address - Phone:917-593-2496
Mailing Address - Fax:
Practice Address - Street 1:41 W 112TH ST
Practice Address - Street 2:3J
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10026-3915
Practice Address - Country:US
Practice Address - Phone:917-593-2496
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-19
Last Update Date:2012-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist