Provider Demographics
NPI:1033543368
Name:DR. JEFFREY S. SELMAN LLC
Entity Type:Organization
Organization Name:DR. JEFFREY S. SELMAN LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:SOTT
Authorized Official - Last Name:SELMAN
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:917-771-9334
Mailing Address - Street 1:86 WARREN ST
Mailing Address - Street 2:APT A
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29403-6026
Mailing Address - Country:US
Mailing Address - Phone:917-771-9334
Mailing Address - Fax:
Practice Address - Street 1:9225 UNIVERSITY BLVD
Practice Address - Street 2:SUITE E2C
Practice Address - City:NORTH CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29406-9149
Practice Address - Country:US
Practice Address - Phone:843-569-4546
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-22
Last Update Date:2013-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty