Provider Demographics
NPI:1134643232
Name:GILBERT, SELENA M (M ED, M ED)
Entity Type:Individual
Prefix:
First Name:SELENA
Middle Name:M
Last Name:GILBERT
Suffix:
Gender:F
Credentials:M ED, M ED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1529 N 19TH ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19121-4120
Mailing Address - Country:US
Mailing Address - Phone:215-432-5101
Mailing Address - Fax:
Practice Address - Street 1:1529 N 19TH ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19121-4120
Practice Address - Country:US
Practice Address - Phone:215-432-5101
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-31
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PABH001209101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health