Provider Demographics
NPI:1235567595
Name:MCDERMOTT-SELMAN, JACQUELINE PATRICIA (MS, MED)
Entity Type:Individual
Prefix:MS
First Name:JACQUELINE
Middle Name:PATRICIA
Last Name:MCDERMOTT-SELMAN
Suffix:
Gender:F
Credentials:MS, MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:148 HAROLD ST
Mailing Address - Street 2:
Mailing Address - City:HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06112-1022
Mailing Address - Country:US
Mailing Address - Phone:860-983-7388
Mailing Address - Fax:
Practice Address - Street 1:330 MARKET ST
Practice Address - Street 2:
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06120-2901
Practice Address - Country:US
Practice Address - Phone:860-761-7922
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-10-24
Last Update Date:2013-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)