Provider Demographics
NPI:1477069185
Name:DELGADO, SELENA (MS ED)
Entity Type:Individual
Prefix:
First Name:SELENA
Middle Name:
Last Name:DELGADO
Suffix:
Gender:F
Credentials:MS ED
Other - Prefix:MS
Other - First Name:SELENA
Other - Middle Name:
Other - Last Name:APONTE DELGADO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MS ED
Mailing Address - Street 1:6407 COOPER AVE
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:NY
Mailing Address - Zip Code:11385-6140
Mailing Address - Country:US
Mailing Address - Phone:347-324-6335
Mailing Address - Fax:
Practice Address - Street 1:64-07 COOPER AVENUE
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:NY
Practice Address - Zip Code:11385
Practice Address - Country:US
Practice Address - Phone:347-324-6335
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-18
Last Update Date:2017-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty