Provider Demographics
NPI:1114008182
Name:SEGALL, MERAV (MA)
Entity type:Individual
Prefix:
First Name:MERAV
Middle Name:
Last Name:SEGALL
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:MERAV
Other - Middle Name:
Other - Last Name:GRUER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA
Mailing Address - Street 1:8601 AERO DR
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92123-1724
Mailing Address - Country:US
Mailing Address - Phone:619-322-0014
Mailing Address - Fax:619-342-8243
Practice Address - Street 1:8601 AERO DR
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92123-1724
Practice Address - Country:US
Practice Address - Phone:619-322-0014
Practice Address - Fax:619-342-8243
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-18
Last Update Date:2011-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC48272106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist