Provider Demographics
NPI:1760746580
Name:RAVEN, SELMA ANNE (MS ED)
Entity Type:Individual
Prefix:MS
First Name:SELMA
Middle Name:ANNE
Last Name:RAVEN
Suffix:
Gender:F
Credentials:MS ED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:412 W 260TH ST
Mailing Address - Street 2:BRONX
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10471-1820
Mailing Address - Country:US
Mailing Address - Phone:917-533-7196
Mailing Address - Fax:
Practice Address - Street 1:412 W 260TH ST
Practice Address - Street 2:BRONX
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10471-1820
Practice Address - Country:US
Practice Address - Phone:917-533-7196
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-26
Last Update Date:2013-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY724719174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist