Provider Demographics
NPI:1487898359
Name:SEGARRA, MARY L (PHD)
Entity type:Individual
Prefix:DR
First Name:MARY
Middle Name:L
Last Name:SEGARRA
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:350 CENTRAL PARK WEST
Mailing Address - Street 2:#1AD
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10025
Mailing Address - Country:US
Mailing Address - Phone:212-316-3264
Mailing Address - Fax:212-864-4627
Practice Address - Street 1:350 CENTRAL PARK W
Practice Address - Street 2:#1AD
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10025-6547
Practice Address - Country:US
Practice Address - Phone:212-316-3264
Practice Address - Fax:212-864-4627
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-23
Last Update Date:2009-04-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY0111561103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical