Provider Demographics
NPI:1558816645
Name:SEGALL, YTAMAR (MA, BCBA)
Entity Type:Individual
Prefix:
First Name:YTAMAR
Middle Name:
Last Name:SEGALL
Suffix:
Gender:M
Credentials:MA, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:624 91ST ST
Mailing Address - Street 2:
Mailing Address - City:SURFSIDE
Mailing Address - State:FL
Mailing Address - Zip Code:33154-3131
Mailing Address - Country:US
Mailing Address - Phone:702-374-7148
Mailing Address - Fax:
Practice Address - Street 1:624 91ST ST
Practice Address - Street 2:
Practice Address - City:SURFSIDE
Practice Address - State:FL
Practice Address - Zip Code:33154-3131
Practice Address - Country:US
Practice Address - Phone:702-374-7148
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-18
Last Update Date:2020-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV0-17-8022106E00000X
NVRBT1624285106S00000X
1-18-29543103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician