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General NPI Number Information
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NPI Number | 1699955500
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Entity Type | Individual
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Provider Name | ELIDA M SEGRERA M. S.
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Gender | Female
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Dates
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Enumeration Date | 11/08/2007
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Last Update Date | 01/07/2011
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Provider Practice Location Address
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Address Line | 351 N. STATE ROAD 7 SUITE 200
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City | PLANTATION
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State | FL
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Zip | 33317-2859
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Country | US
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Telephone | 954-327-4069
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Fax | 954-792-9122
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Provider Business Mailing Address
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Address Line | 351 N. STATE ROAD 7 SUITE 200
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City | PLANTATION
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State | FL
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Zip | 33317-2859
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Country | US
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Telephone | 954-327-4069
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Fax | 954-792-9122
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | MT 2187
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License Number State | FL
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