Provider Demographics
NPI:1184348419
Name:SEGARRA DAVILA, HEIDI (PHD)
Entity type:Individual
Prefix:DR
First Name:HEIDI
Middle Name:
Last Name:SEGARRA DAVILA
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 PASEO DEL PUERTO APT 123
Mailing Address - Street 2:
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00716-1218
Mailing Address - Country:US
Mailing Address - Phone:939-217-8700
Mailing Address - Fax:
Practice Address - Street 1:GALERIA PROFESIONAL
Practice Address - Street 2:SUITE 102 CALLE CONCORDIA
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00717-1562
Practice Address - Country:US
Practice Address - Phone:939-835-7257
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-29
Last Update Date:2023-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR7465103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical