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General NPI Number Information
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NPI Number | 1245529296
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Entity Type | Organization
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Legal Business Name | SEGAL TELEPSYCHIATRY NETWORK
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Dates
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Enumeration Date | 03/30/2011
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Last Update Date | 03/30/2011
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Provider Practice Location Address
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Address Line | 655 REDWOOD HWY FRONTAGE RD SUITE 240
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City | MILL VALLEY
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State | CA
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Zip | 94941-3034
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Country | US
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Telephone | 866-247-4292
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Fax | 866-247-4293
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Provider Business Mailing Address
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Address Line | 655 REDWOOD HWY FRONTAGE RD SUITE 240
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City | MILL VALLEY
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State | CA
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Zip | 94941-3034
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Country | US
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Telephone | 866-247-4292
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Fax | 866-247-4293
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Authorized Official
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Title or Position | PRESIDENT
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Name | OLGA SEGAL
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Credential | MD
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Telephone | 707-205-7566
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 102L00000X
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Taxonomy Name | Psychoanalyst
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License Number | A85774
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License Number State | CA
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