Basic Information
| Provider Information | |||||||||
| NPI: | 1861740052 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SEGURA | ||||||||
| FirstName: | CRYSTAL | ||||||||
| MiddleName: | VERONICA | ||||||||
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| Credential: | MSW, ASW 36809 | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1288 | ||||||||
| Address2: | |||||||||
| City: | MADERA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 936391288 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5596733508 | ||||||||
| FaxNumber: | 5596757758 | ||||||||
| Practice Location | |||||||||
| Address1: | 209 E 7TH ST | ||||||||
| Address2: | |||||||||
| City: | MADERA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 936383780 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5596733580 | ||||||||
| FaxNumber: | 5596612818 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/21/2012 | ||||||||
| LastUpdateDate: | 09/16/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | N | Behavioral Health & Social Service Providers | Social Worker | 1041C0700X | ASW 36809 | CA | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical | 101YM0800X | ASW36809 | CA | N | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.