Provider Demographics
NPI:1558501676
Name:SEGAL, ROBERTA AGATHA (MA)
Entity Type:Individual
Prefix:MS
First Name:ROBERTA
Middle Name:AGATHA
Last Name:SEGAL
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1607 MCALLISTER ST
Mailing Address - Street 2:APT. A
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94115-4413
Mailing Address - Country:US
Mailing Address - Phone:415-673-8883
Mailing Address - Fax:
Practice Address - Street 1:2675 FOLSOM ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94110-3325
Practice Address - Country:US
Practice Address - Phone:415-643-7117
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-03-02
Last Update Date:2009-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFTI #59316101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health