Provider Demographics
NPI:1831132521
Name:SELZER, EDITH L (LCSW)
Entity Type:Individual
Prefix:
First Name:EDITH
Middle Name:L
Last Name:SELZER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:777 PASSAIC AVENUE
Mailing Address - Street 2:SUITE 365
Mailing Address - City:CLIFTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07012-1873
Mailing Address - Country:US
Mailing Address - Phone:973-815-0777
Mailing Address - Fax:973-815-0737
Practice Address - Street 1:777 PASSAIC AVENUE
Practice Address - Street 2:SUITE 365
Practice Address - City:CLIFTON
Practice Address - State:NJ
Practice Address - Zip Code:07012-1873
Practice Address - Country:US
Practice Address - Phone:973-815-0777
Practice Address - Fax:973-815-0737
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-13
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC002770001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJSE786188Medicare PIN