Provider Demographics
NPI:1629784509
Name:SEGNINI, CAROL MAYELA
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:MAYELA
Last Name:SEGNINI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5613 GOLDFISH ST
Mailing Address - Street 2:
Mailing Address - City:LUTZ
Mailing Address - State:FL
Mailing Address - Zip Code:33558-5901
Mailing Address - Country:US
Mailing Address - Phone:813-900-3921
Mailing Address - Fax:
Practice Address - Street 1:5613 GOLDFISH ST
Practice Address - Street 2:
Practice Address - City:LUTZ
Practice Address - State:FL
Practice Address - Zip Code:33558-5901
Practice Address - Country:US
Practice Address - Phone:813-900-3921
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-25
Last Update Date:2023-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL22-248-162106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician