Provider Demographics
NPI:1215396833
Name:SELMAN, JUDY
Entity Type:Individual
Prefix:
First Name:JUDY
Middle Name:
Last Name:SELMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 ROXBURY ST
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:ROXBURY
Mailing Address - State:MA
Mailing Address - Zip Code:02119-1720
Mailing Address - Country:US
Mailing Address - Phone:617-516-0280
Mailing Address - Fax:617-516-0281
Practice Address - Street 1:11 ROXBURY ST
Practice Address - Street 2:2ND FLOOR
Practice Address - City:ROXBURY
Practice Address - State:MA
Practice Address - Zip Code:02119-1720
Practice Address - Country:US
Practice Address - Phone:617-516-0280
Practice Address - Fax:617-516-0281
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-11
Last Update Date:2016-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health