Provider Demographics
NPI:1932129335
Name:SELBY, ROSEMARY (PHD)
Entity Type:Individual
Prefix:DR
First Name:ROSEMARY
Middle Name:
Last Name:SELBY
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2555 PARK BLVD STE 5
Mailing Address - Street 2:
Mailing Address - City:PALO ALTO
Mailing Address - State:CA
Mailing Address - Zip Code:94306-1919
Mailing Address - Country:US
Mailing Address - Phone:650-323-3532
Mailing Address - Fax:650-325-9593
Practice Address - Street 1:2555 PARK BLVD STE 5
Practice Address - Street 2:
Practice Address - City:PALO ALTO
Practice Address - State:CA
Practice Address - Zip Code:94306-1919
Practice Address - Country:US
Practice Address - Phone:650-323-3532
Practice Address - Fax:650-325-9593
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 9340103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical