Provider Demographics
NPI:1922362938
Name:DRSELENA
Entity Type:Organization
Organization Name:DRSELENA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / CLINICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:SELENA
Authorized Official - Middle Name:ROSE
Authorized Official - Last Name:EMOND
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, BCBA-D
Authorized Official - Phone:949-338-2995
Mailing Address - Street 1:27 NEW YORK CT
Mailing Address - Street 2:
Mailing Address - City:MONARCH BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92629-4524
Mailing Address - Country:US
Mailing Address - Phone:949-528-5013
Mailing Address - Fax:
Practice Address - Street 1:27 NEW YORK CT
Practice Address - Street 2:
Practice Address - City:MONARCH BEACH
Practice Address - State:CA
Practice Address - Zip Code:92629-4524
Practice Address - Country:US
Practice Address - Phone:949-528-5013
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-25
Last Update Date:2017-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1-04-1851103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty