NPIMap

Organization Active NPI

Segal Telepsychiatry Network

  • Psychoanalyst
  • Mill Valley, CA
National Provider Identifier
1245529296
Registry record updated Mar 30, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
PsychoanalystTaxonomy code 102L00000X
License
A85774 Issued in CA
Legal business name
SEGAL TELEPSYCHIATRY NETWORK
Practice address
655 Redwood Hwy Frontage Rd
Suite 240
Mill Valley, CA 94941-3034
Phone
(866) 247-4292
Fax
(866) 247-4293
NPI assigned
Mar 30, 2011
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 30, 2011

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Olga Segal, MDNPI 1821013764
Title
President
Phone
(707) 205-7566

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
PsychoanalystGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 102L00000X A85774 CA Primary

Addresses

Primary practice location

655 Redwood Hwy Frontage Rd
Suite 240
Mill Valley, CA 94941-3034

Mailing address

655 Redwood Hwy Frontage Rd
Suite 240
Mill Valley, CA 94941-3034
Phone (866) 247-4292

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20120525000350 CA Part B Supplier - Clinic/Group Practice 1951564111 Receives reassigned benefits from 9 practitioners
Practice locations: Lakeport, CA; Mill Valley, CA; Ukiah, CA

National Provider Directory

National Provider Directory

Locations

655 Redwood Hwy Frontage Rd
Ste 240
Mill Valley, CA 94941
Phone (866) 247-4292

350 E Gobbi St
#B
Ukiah, CA 95482
Phone (707) 472-0350

Practitioners & affiliated clinicians

Practitioners 12

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1301443200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1301443200000",
    "number": "1245529296",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "655 REDWOOD HWY FRONTAGE RD",
            "address_2": "SUITE 240",
            "city": "MILL VALLEY",
            "state": "CA",
            "postal_code": "949413034",
            "telephone_number": "866-247-4292",
            "fax_number": "866-247-4293"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "655 REDWOOD HWY FRONTAGE RD",
            "address_2": "SUITE 240",
            "city": "MILL VALLEY",
            "state": "CA",
            "postal_code": "949413034",
            "telephone_number": "866-247-4292",
            "fax_number": "866-247-4293"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SEGAL TELEPSYCHIATRY NETWORK",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-03-30",
        "last_updated": "2011-03-30",
        "status": "A",
        "authorized_official_last_name": "SEGAL",
        "authorized_official_first_name": "OLGA",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "707-205-7566",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "102L00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Psychoanalyst",
            "state": "CA",
            "license": "A85774",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Mill Valley, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 30, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.