Provider Demographics
NPI:1033482690
Name:AMSELLEM, MARNI S (PHD)
Entity Type:Individual
Prefix:
First Name:MARNI
Middle Name:S
Last Name:AMSELLEM
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:MARNA (LEGAL NAME)
Other - Middle Name:S
Other - Last Name:AMSELLEM
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:501 E BOSTON POST RD
Mailing Address - Street 2:
Mailing Address - City:MAMARONECK
Mailing Address - State:NY
Mailing Address - Zip Code:10543-3757
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:501 E BOSTON POST RD
Practice Address - Street 2:
Practice Address - City:MAMARONECK
Practice Address - State:NY
Practice Address - Zip Code:10543-3757
Practice Address - Country:US
Practice Address - Phone:202-210-1517
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-02-13
Last Update Date:2016-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY018440103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical