Provider Demographics
NPI:1609620400
Name:LINDAMOOD, SELENA RHYAN (LAC)
Entity Type:Individual
Prefix:
First Name:SELENA
Middle Name:RHYAN
Last Name:LINDAMOOD
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2601 PENNINGTON RD
Mailing Address - Street 2:
Mailing Address - City:PENNINGTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08534-3208
Mailing Address - Country:US
Mailing Address - Phone:609-947-4462
Mailing Address - Fax:
Practice Address - Street 1:3117 STATE ROUTE 10
Practice Address - Street 2:
Practice Address - City:DENVILLE
Practice Address - State:NJ
Practice Address - Zip Code:07834-3625
Practice Address - Country:US
Practice Address - Phone:973-525-2815
Practice Address - Fax:862-304-5659
Is Sole Proprietor?:No
Enumeration Date:2024-04-16
Last Update Date:2024-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37AC00752200101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health