Provider Demographics
NPI:1457967424
Name:SEGAL, RHONDA MARA (LMSW)
Entity Type:Individual
Prefix:
First Name:RHONDA
Middle Name:MARA
Last Name:SEGAL
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:485 UNDERHILL BLVD STE 107
Mailing Address - Street 2:
Mailing Address - City:SYOSSET
Mailing Address - State:NY
Mailing Address - Zip Code:11791-3434
Mailing Address - Country:US
Mailing Address - Phone:516-921-0189
Mailing Address - Fax:
Practice Address - Street 1:485 UNDERHILL BLVD STE 107
Practice Address - Street 2:
Practice Address - City:SYOSSET
Practice Address - State:NY
Practice Address - Zip Code:11791-3434
Practice Address - Country:US
Practice Address - Phone:516-921-0189
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-16
Last Update Date:2020-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY086412104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1033610084Other03-0544495