Provider Demographics
NPI:1609918408
Name:SEGISMUNDO, ERNESTO CASASOLA JR (LMFT)
Entity Type:Individual
Prefix:MR
First Name:ERNESTO
Middle Name:CASASOLA
Last Name:SEGISMUNDO
Suffix:JR
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9191 ENLOE WAY
Mailing Address - Street 2:
Mailing Address - City:GARDEN GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:92844-2707
Mailing Address - Country:US
Mailing Address - Phone:909-247-8820
Mailing Address - Fax:
Practice Address - Street 1:915 W IMPERIAL HWY
Practice Address - Street 2:SUITE 150
Practice Address - City:BREA
Practice Address - State:CA
Practice Address - Zip Code:92821-3835
Practice Address - Country:US
Practice Address - Phone:909-247-8820
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-12
Last Update Date:2011-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC49640106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist