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NPI Code Detail

MEDICARE: DR. THERESA SEGURA-HERRERA PH.D.

MEDICARE: DR. THERESA SEGURA-HERRERA PH.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103TC0700XClinical Psychologist071.008568IL

General Provider Information

NPI Number : 1871936377
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. THERESA SEGURA-HERRERA PH.D.
Provider Business Mailing Address
First Line : 4343 N CLARENDON AVE
Second Line : SUITE 2110
City : CHICAGO
State : IL
Zip : 60613-2698
Country : US
Telephone Number : 312-909-1007
Fax Number : 773-327-4542
Provider Business Practice Location Address
First Line : 6250 W NORTH AVE
Second Line : 1ST FL
City : CHICAGO
State : IL
Zip : 60639-3861
Country : US
Telephone Number : 312-909-1007
Fax Number : 773-327-4542
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/15/2013
Last Update Date : 05/08/2013

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