Healthcare Provider Details

I. General information

NPI: 1558501676
Provider Name (Legal Business Name): ROBERTA AGATHA SEGAL MA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/02/2009
Last Update Date: 03/02/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2675 FOLSOM ST
SAN FRANCISCO CA
94110-3325
US

IV. Provider business mailing address

1607 MCALLISTER ST APT. A
SAN FRANCISCO CA
94115-4413
US

V. Phone/Fax

Practice location:
  • Phone: 415-643-7117
  • Fax:
Mailing address:
  • Phone: 415-673-8883
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMFTI #59316
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: