Provider Demographics
NPI:1497759419
Name:SEGARRA, EFRAIN (PHD)
Entity Type:Individual
Prefix:DR
First Name:EFRAIN
Middle Name:
Last Name:SEGARRA
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5557 CARYS BROOK LN
Mailing Address - Street 2:
Mailing Address - City:GLOUCESTER
Mailing Address - State:VA
Mailing Address - Zip Code:23061-2002
Mailing Address - Country:US
Mailing Address - Phone:757-344-6747
Mailing Address - Fax:804-695-1815
Practice Address - Street 1:5557 CARYS BROOK LN
Practice Address - Street 2:
Practice Address - City:GLOUCESTER
Practice Address - State:VA
Practice Address - Zip Code:23061-2002
Practice Address - Country:US
Practice Address - Phone:757-344-6747
Practice Address - Fax:804-695-1815
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-08
Last Update Date:2008-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810001283103TC0700X, 103TC2200X, 103TF0200X, 103G00000X, 103TA0700X, 103T00000X, 103TP2701X, 103TF0000X, 103TB0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
No103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensic
No103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
No103TA0700XBehavioral Health & Social Service ProvidersPsychologistAdult Development & Aging
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup Psychotherapy
No103TF0000XBehavioral Health & Social Service ProvidersPsychologistFamily
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA289120OtherANTHEM BLUE CROSS
VA010164206Medicaid
VA010164851Medicaid
VA190000806Medicare ID - Type Unspecified