Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TS0200X | School Psychologist |
NPI | 1003350141 |
---|---|
Provider Name | Carlos D Segarra |
First Address | Kissimmee, FL 34758-2165 |
Second Address | Kissimmee, FL 34744-1607 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/12/2016 |
Last Update Date | 08/12/2016 |