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General NPI Number Information
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NPI Number | 1871936377
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Entity Type | Individual
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Provider Name | THERESA SEGURA-HERRERA PH.D.
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Gender | Female
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Dates
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Enumeration Date | 04/15/2013
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Last Update Date | 05/08/2013
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Provider Practice Location Address
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Address Line | 6250 W NORTH AVE 1ST FL
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City | CHICAGO
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State | IL
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Zip | 60639-3861
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Country | US
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Telephone | 312-909-1007
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Fax | 773-327-4542
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Provider Business Mailing Address
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Address Line | 4343 N CLARENDON AVE SUITE 2110
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City | CHICAGO
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State | IL
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Zip | 60613-2698
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Country | US
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Telephone | 312-909-1007
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Fax | 773-327-4542
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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 | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 071.008568
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License Number State | IL
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