Individual
MICHELLE SEGRETTO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMSW, BCBA
Contact information
Practice address
140 RIDGE RD, RIDGE, NY 11961-1000
(631) 553-5263
Mailing address
140 RIDGE RD, RIDGE, NY 11961-1000
(631) 553-5263
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
BACB234772
NY
104100000X
Social Worker
079576
NY
Other
Enumeration date
01/20/2015
Last updated
01/20/2015
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