Provider Demographics
NPI:1265834493
Name:SELIG, CHARLOTTE (PSYD)
Entity Type:Individual
Prefix:
First Name:CHARLOTTE
Middle Name:
Last Name:SELIG
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 NEWLAND CT
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19713-2815
Mailing Address - Country:US
Mailing Address - Phone:302-345-4493
Mailing Address - Fax:
Practice Address - Street 1:19 NEWLAND CT
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19713-2815
Practice Address - Country:US
Practice Address - Phone:302-345-4493
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-18
Last Update Date:2014-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEB1-0000697103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical