Provider Demographics
NPI:1356487938
Name:SELLMAN, STEPHANIE DENEENE (LCSWC)
Entity Type:Individual
Prefix:MS
First Name:STEPHANIE
Middle Name:DENEENE
Last Name:SELLMAN
Suffix:
Gender:F
Credentials:LCSWC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1307 ROOSEVELT ST
Mailing Address - Street 2:
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21403-2120
Mailing Address - Country:US
Mailing Address - Phone:443-542-1640
Mailing Address - Fax:
Practice Address - Street 1:1307 ROOSEVELT ST
Practice Address - Street 2:
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21403-2120
Practice Address - Country:US
Practice Address - Phone:443-542-1640
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD12690103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
462SMedicare ID - Type Unspecified