Provider Demographics
NPI:1124518246
Name:SEGNERI, MELINA (BCBA 1-21-53007)
Entity type:Individual
Prefix:
First Name:MELINA
Middle Name:
Last Name:SEGNERI
Suffix:
Gender:F
Credentials:BCBA 1-21-53007
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:820 DANFORTH ST
Mailing Address - Street 2:
Mailing Address - City:ALTON
Mailing Address - State:IL
Mailing Address - Zip Code:62002-2203
Mailing Address - Country:US
Mailing Address - Phone:618-610-3123
Mailing Address - Fax:
Practice Address - Street 1:2014 N MILWAUKEE AVE APT 201
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60647-8478
Practice Address - Country:US
Practice Address - Phone:618-610-3123
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-14
Last Update Date:2021-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ILRBT-17-46948106S00000X
IL1-21-53007103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician