MEDICARE: DR. ROSEMARY A. SEGALLA ROSEMARY SEGALLA 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	DC 1066	DC

General Provider Information

NPI Number	:	1508177288
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROSEMARY A. SEGALLA ROSEMARY SEGALLA PHD

Provider Business Mailing Address
First Line	:	3551 WINFIELD LN NW
Second Line	:
City	:	WASHINGTON
State	:	DC
Zip	:	20007-2368
Country	:	US
Telephone Number	:	202-965-1134
Fax Number	:	202-333-1663

Provider Business Practice Location Address
First Line	:	3551 WINFIELD LN NW
Second Line	:
City	:	WASHINGTON
State	:	DC
Zip	:	20007-2368
Country	:	US
Telephone Number	:	202-965-1134
Fax Number	:	202-333-1663

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

Provider Enumeration Date	:	06/28/2010
Last Update Date	:	06/28/2010

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