Provider Demographics
NPI:1518674852
Name:SEGAL TELEPSYCHIATRY NETWORK, PLLC
Entity Type:Organization
Organization Name:SEGAL TELEPSYCHIATRY NETWORK, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:OLGA
Authorized Official - Middle Name:
Authorized Official - Last Name:SEGAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:707-205-7566
Mailing Address - Street 1:655 REDWOOD HWY FRONTAGE RD STE 240
Mailing Address - Street 2:
Mailing Address - City:MILL VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:94941-3055
Mailing Address - Country:US
Mailing Address - Phone:707-205-7566
Mailing Address - Fax:
Practice Address - Street 1:655 REDWOOD HWY FRONTAGE RD STE 240
Practice Address - Street 2:
Practice Address - City:MILL VALLEY
Practice Address - State:CA
Practice Address - Zip Code:94941-3055
Practice Address - Country:US
Practice Address - Phone:707-205-7566
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-04
Last Update Date:2022-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLNONEMedicaid