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General NPI Number Information
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NPI Number | 1609238245
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Entity Type | Organization
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Legal Business Name | PEDRO E. SEGARRA
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Dates
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Enumeration Date | 03/23/2016
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Last Update Date | 03/23/2016
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Provider Practice Location Address
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Address Line | 760 PROSPECT AVENUE
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City | HARTFORD
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State | CT
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Zip | 06105
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Country | US
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Telephone | 860-805-2400
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Fax | 860-570-0195
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Provider Business Mailing Address
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Address Line | 760 PROSPECT AVENUE
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City | HARTFORD
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State | CT
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Zip | 06105
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Country | US
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Telephone | 860-805-2400
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Fax | 860-570-0195
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Authorized Official
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Title or Position | MASTERS LEVEL SOCIAL WORKER
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Name | MR. PEDRO ERNESTO SEGARRA
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Credential | LMSW
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Telephone | 860-805-2400
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 003180
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License Number State | CT
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