Provider Demographics
NPI:1740587039
Name:SELKOVITS, DAVID RADER
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:RADER
Last Name:SELKOVITS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 EMERSON PLACE
Mailing Address - Street 2:APT. 21B
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02114-2236
Mailing Address - Country:US
Mailing Address - Phone:617-308-8219
Mailing Address - Fax:
Practice Address - Street 1:10 EMERSON PL
Practice Address - Street 2:APT. 21B
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114-2204
Practice Address - Country:US
Practice Address - Phone:617-308-8219
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-02-22
Last Update Date:2015-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
17470587039101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health