| Segal Telepsychiatry Network, Pllc | |
|
655 Redwood Hwy Frontage Rd Ste 240 Mill Valley CA 94941-3055 | |
| (707) 205-7566 | |
| Not Available |
| Full Name | Segal Telepsychiatry Network, Pllc |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 655 Redwood Hwy Frontage Rd Ste 240, Mill Valley, California |
| Authorized Official Name and Position | Olga Segal (MEDICAL DIRECTOR) |
| Authorized Official Contact | 7072057566 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Segal Telepsychiatry Network, Pllc 655 Redwood Hwy Frontage Rd Ste 240 Mill Valley CA 94941-3055 Ph: (707) 205-7566 | Segal Telepsychiatry Network, Pllc 655 Redwood Hwy Frontage Rd Ste 240 Mill Valley CA 94941-3055 Ph: (707) 205-7566 |
| NPI Number | 1518674852 |
|---|---|
| Provider Enumeration Date | 11/04/2022 |
| Last Update Date | 11/04/2022 |
| Certification Date | 11/04/2022 |
| Medicare PECOS PAC ID | 1254799471 |
|---|---|
| Medicare Enrollment ID | O20230621001075 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1518674852 | NPI | - | NPPES |
| NONE | Medicaid | FL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084P0800X | Psychiatry & Neurology - Psychiatry | (* (Not Available)) | Primary |
| Provider Name | Lisa A Youngblood |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1801843941 PECOS PAC ID: 1658384680 Enrollment ID: I20210322001737 |
| Provider Name | Olga Segal |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1821013764 PECOS PAC ID: 3375553910 Enrollment ID: I20230621001565 |
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