Provider Demographics
NPI:1598180119
Name:MARY CATHERINE SEGOTA PSYD PA
Entity Type:Organization
Organization Name:MARY CATHERINE SEGOTA PSYD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARY-CATHERINE
Authorized Official - Middle Name:
Authorized Official - Last Name:SEGOTA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-654-4433
Mailing Address - Street 1:13350 W COLONIAL DR
Mailing Address - Street 2:SUITE #340
Mailing Address - City:WINTER GARDEN
Mailing Address - State:FL
Mailing Address - Zip Code:34787-3964
Mailing Address - Country:US
Mailing Address - Phone:407-654-4433
Mailing Address - Fax:
Practice Address - Street 1:13350 W COLONIAL DR
Practice Address - Street 2:SUITE #340
Practice Address - City:WINTER GARDEN
Practice Address - State:FL
Practice Address - Zip Code:34787-3964
Practice Address - Country:US
Practice Address - Phone:407-654-4433
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-19
Last Update Date:2015-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY7123103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty