Healthcare Provider Details

I. General information

NPI: 1740955152
Provider Name (Legal Business Name): KATE S SEGAL PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/09/2021
Last Update Date: 08/09/2021
Certification Date: 08/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

397 BRIDGE ST
BROOKLYN NY
11201-5292
US

IV. Provider business mailing address

2585 BROADWAY # 144
NEW YORK NY
10025-5655
US

V. Phone/Fax

Practice location:
  • Phone: 541-581-0040
  • Fax:
Mailing address:
  • Phone: 541-581-0040
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number024436
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: