Provider Demographics
NPI:1790090785
Name:SELENKO, FELICA (LISA) A (PHD, CGT)
Entity Type:Individual
Prefix:
First Name:FELICA (LISA)
Middle Name:A
Last Name:SELENKO
Suffix:
Gender:F
Credentials:PHD, CGT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:819 FIRST ST
Mailing Address - Street 2:
Mailing Address - City:DUNELLEN
Mailing Address - State:NJ
Mailing Address - Zip Code:08812-1038
Mailing Address - Country:US
Mailing Address - Phone:732-968-7999
Mailing Address - Fax:732-968-0783
Practice Address - Street 1:819 1ST ST
Practice Address - Street 2:
Practice Address - City:DUNELLEN
Practice Address - State:NJ
Practice Address - Zip Code:08812-1038
Practice Address - Country:US
Practice Address - Phone:732-968-7999
Practice Address - Fax:732-968-0783
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-13
Last Update Date:2011-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health