Provider Demographics
NPI:1457495111
Name:FOGEL, MARGARET SELKIN (PHD)
Entity Type:Individual
Prefix:DR
First Name:MARGARET
Middle Name:SELKIN
Last Name:FOGEL
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 HOMESTEAD STREET
Mailing Address - Street 2:
Mailing Address - City:NEWTON
Mailing Address - State:MA
Mailing Address - Zip Code:02468
Mailing Address - Country:US
Mailing Address - Phone:617-332-0137
Mailing Address - Fax:617-332-0124
Practice Address - Street 1:15 HOMESTEAD STREET
Practice Address - Street 2:
Practice Address - City:NEWTON
Practice Address - State:MA
Practice Address - Zip Code:02468
Practice Address - Country:US
Practice Address - Phone:617-332-0137
Practice Address - Fax:617-332-0124
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-16
Last Update Date:2018-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2092103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MANPI # 1457495111OtherHARVARD-PILGRIM (UNITED BEHAVIORAL HEALTHCARE
MAWO2283OtherBLUE CROSS/BLUE SHIELD
MA$$$$$$$$$OtherUNITED HEALTHCARE