Provider Demographics
NPI:1467906792
Name:SELDEN, SARAH (PHD)
Entity Type:Individual
Prefix:DR
First Name:SARAH
Middle Name:
Last Name:SELDEN
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 1:675 SACKETT ST
Mailing Address - Street 2:APT 107
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11217-3126
Mailing Address - Country:US
Mailing Address - Phone:413-330-8280
Mailing Address - Fax:
Practice Address - Street 1:1115 BROADWAY
Practice Address - Street 2:SUITE 1250
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10010-3450
Practice Address - Country:US
Practice Address - Phone:917-960-8285
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-03
Last Update Date:2016-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY68021734103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling