Provider Demographics
NPI:1609238245
Name:PEDRO E. SEGARRA
Entity Type:Organization
Organization Name:PEDRO E. SEGARRA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MASTERS LEVEL SOCIAL WORKER
Authorized Official - Prefix:MR
Authorized Official - First Name:PEDRO
Authorized Official - Middle Name:ERNESTO
Authorized Official - Last Name:SEGARRA
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW
Authorized Official - Phone:860-805-2400
Mailing Address - Street 1:760 PROSPECT AVENUE
Mailing Address - Street 2:
Mailing Address - City:HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06105
Mailing Address - Country:US
Mailing Address - Phone:860-805-2400
Mailing Address - Fax:860-570-0195
Practice Address - Street 1:760 PROSPECT AVENUE
Practice Address - Street 2:
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06105
Practice Address - Country:US
Practice Address - Phone:860-805-2400
Practice Address - Fax:860-570-0195
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-23
Last Update Date:2016-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0031801041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty