Provider Demographics
NPI:1942581301
Name:SEGATOL-ISLAMI, ROSHAN LOUISE
Entity Type:Individual
Prefix:
First Name:ROSHAN
Middle Name:LOUISE
Last Name:SEGATOL-ISLAMI
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 1:806 14TH ST
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94114-1104
Mailing Address - Country:US
Mailing Address - Phone:301-775-2252
Mailing Address - Fax:
Practice Address - Street 1:559 16TH ST
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94612-1515
Practice Address - Country:US
Practice Address - Phone:510-419-1010
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-30
Last Update Date:2019-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA92971106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist