MEDICARE: DR. EFRAIN SEGARRA PHD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	0810001283	VA
2	103TC2200X	Clinical Child & Adolescent Psychologist	0810001283	VA
3	103TF0200X	Forensic Psychologist	0810001283	VA
4	103G00000X	Clinical Neuropsychologist	0810001283	VA
5	103TA0700X	Adult Development & Aging Psychologist	0810001283	VA
6	103T00000X	Psychologist	0810001283	VA
7	103TP2701X	Group Psychotherapy Psychologist	0810001283	VA
8	103TF0000X	Family Psychologist	0810001283	VA
9	103TB0200X	Cognitive & Behavioral Psychologist	0810001283	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	289120	OTHER	VA	ANTHEM BLUE CROSS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1497759419
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. EFRAIN SEGARRA PHD

Provider Business Mailing Address
First Line	:	5557 CARYS BROOK LN
Second Line	:
City	:	GLOUCESTER
State	:	VA
Zip	:	23061-2002
Country	:	US
Telephone Number	:	757-344-6747
Fax Number	:	804-695-1815

Provider Business Practice Location Address
First Line	:	5557 CARYS BROOK LN
Second Line	:
City	:	GLOUCESTER
State	:	VA
Zip	:	23061-2002
Country	:	US
Telephone Number	:	757-344-6747
Fax Number	:	804-695-1815

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/08/2005
Last Update Date	:	10/29/2008

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