Provider Demographics
NPI:1477263812
Name:CALVIN, SELINA MARIE
Entity Type:Individual
Prefix:
First Name:SELINA
Middle Name:MARIE
Last Name:CALVIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:176 DIVISION ST APT 409
Mailing Address - Street 2:
Mailing Address - City:TRENTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08611-1043
Mailing Address - Country:US
Mailing Address - Phone:908-674-2796
Mailing Address - Fax:
Practice Address - Street 1:176 DIVISION ST APT 409
Practice Address - Street 2:
Practice Address - City:TRENTON
Practice Address - State:NJ
Practice Address - Zip Code:08611-1043
Practice Address - Country:US
Practice Address - Phone:908-674-2796
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-28
Last Update Date:2022-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health