Provider Demographics
NPI:1568744159
Name:SELETSKY, RONALD A (LSW, LMHC)
Entity Type:Individual
Prefix:MR
First Name:RONALD
Middle Name:A
Last Name:SELETSKY
Suffix:
Gender:M
Credentials:LSW, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27 WESTGATE RD
Mailing Address - Street 2:SUITE 4
Mailing Address - City:CHESTNUT HILL
Mailing Address - State:MA
Mailing Address - Zip Code:02467-3405
Mailing Address - Country:US
Mailing Address - Phone:617-233-3757
Mailing Address - Fax:
Practice Address - Street 1:27 WESTGATE RD
Practice Address - Street 2:SUITE 4
Practice Address - City:CHESTNUT HILL
Practice Address - State:MA
Practice Address - Zip Code:02467-3405
Practice Address - Country:US
Practice Address - Phone:617-233-3757
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-09
Last Update Date:2011-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4374101YM0800X
MA313686104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No104100000XBehavioral Health & Social Service ProvidersSocial Worker