Provider Demographics
NPI:1477791168
Name:KEPKEP, SELIN SUREYYA (PHD)
Entity Type:Individual
Prefix:DR
First Name:SELIN
Middle Name:SUREYYA
Last Name:KEPKEP
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 1:58 ADAMS CIR
Mailing Address - Street 2:
Mailing Address - City:NORTHBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:01534-1087
Mailing Address - Country:US
Mailing Address - Phone:774-573-8505
Mailing Address - Fax:
Practice Address - Street 1:1 ASH ST
Practice Address - Street 2:
Practice Address - City:HOPKINTON
Practice Address - State:MA
Practice Address - Zip Code:01748-1886
Practice Address - Country:US
Practice Address - Phone:781-987-2089
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-02-03
Last Update Date:2022-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA7329103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical