Provider Demographics
NPI:1689805202
Name:SEGEL, BETH L (PHD)
Entity Type:Individual
Prefix:
First Name:BETH
Middle Name:L
Last Name:SEGEL
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:BETH
Other - Middle Name:L
Other - Last Name:SEGEL-EVANS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9010 RESEDA BOULEVARD
Mailing Address - Street 2:SUITE 106
Mailing Address - City:NORTHRIDGE
Mailing Address - State:CA
Mailing Address - Zip Code:91324-5854
Mailing Address - Country:US
Mailing Address - Phone:818-886-0381
Mailing Address - Fax:
Practice Address - Street 1:9010 RESEDA BOULEVARD
Practice Address - Street 2:SUITE 106
Practice Address - City:NORTHRIDGE
Practice Address - State:CA
Practice Address - Zip Code:91324-5854
Practice Address - Country:US
Practice Address - Phone:818-886-0381
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-07-30
Last Update Date:2009-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY8904103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical