Provider Demographics
NPI:1356459622
Name:SELBY, JOAN (PSYD)
Entity Type:Individual
Prefix:DR
First Name:JOAN
Middle Name:
Last Name:SELBY
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 1:24 NORWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01944-1508
Mailing Address - Country:US
Mailing Address - Phone:978-526-8391
Mailing Address - Fax:
Practice Address - Street 1:24 NORWOOD AVE
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:MA
Practice Address - Zip Code:01944-1508
Practice Address - Country:US
Practice Address - Phone:978-526-8391
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4505103TC0700X
MA169861103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Not Answered103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAW04428OtherB/CB/S MA PROVIDER#
MAW04428Medicare ID - Type UnspecifiedMEDICARE PROV #