Provider Demographics
NPI:1235503228
Name:SELASSIE, MAHSEEYAHU BEN (LGSW)
Entity Type:Individual
Prefix:
First Name:MAHSEEYAHU
Middle Name:BEN
Last Name:SELASSIE
Suffix:
Gender:M
Credentials:LGSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1202 ARGONNE DR
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21218-1429
Mailing Address - Country:US
Mailing Address - Phone:410-917-6212
Mailing Address - Fax:410-889-3544
Practice Address - Street 1:1202 ARGONNE DR
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21218-1429
Practice Address - Country:US
Practice Address - Phone:410-917-6212
Practice Address - Fax:410-889-3544
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-14
Last Update Date:2015-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD184561041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical