Provider Demographics
NPI:1578615381
Name:SELEKMAN, WARREN (PHD)
Entity Type:Individual
Prefix:
First Name:WARREN
Middle Name:
Last Name:SELEKMAN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2880 BAISLEY AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10461-6117
Mailing Address - Country:US
Mailing Address - Phone:718-931-5151
Mailing Address - Fax:718-931-9127
Practice Address - Street 1:2880 BAISLEY AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10461-6117
Practice Address - Country:US
Practice Address - Phone:718-931-5151
Practice Address - Fax:718-931-9127
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-18
Last Update Date:2011-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY4846-1103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01515737Medicaid
NYV14761Medicare ID - Type Unspecified
NYR79359Medicare UPIN