Provider Demographics
NPI:1205474632
Name:SEGARRA, STEPHANIE LIZ (MS)
Entity type:Individual
Prefix:MRS
First Name:STEPHANIE
Middle Name:LIZ
Last Name:SEGARRA
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10141 NW 32ND TER
Mailing Address - Street 2:
Mailing Address - City:DORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33172-5914
Mailing Address - Country:US
Mailing Address - Phone:787-550-8836
Mailing Address - Fax:
Practice Address - Street 1:283 PARK BLVD
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33126-8010
Practice Address - Country:US
Practice Address - Phone:305-262-0099
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-17
Last Update Date:2019-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL18599101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health