Provider Demographics
NPI:1942085329
Name:HERBERT, SELENA J
Entity Type:Individual
Prefix:
First Name:SELENA
Middle Name:J
Last Name:HERBERT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SELENA
Other - Middle Name:J
Other - Last Name:AMES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8 PRIMROSE DR
Mailing Address - Street 2:
Mailing Address - City:TILTON
Mailing Address - State:NH
Mailing Address - Zip Code:03276-5775
Mailing Address - Country:US
Mailing Address - Phone:603-491-9535
Mailing Address - Fax:
Practice Address - Street 1:1750 ELM ST STE 103
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03104-2919
Practice Address - Country:US
Practice Address - Phone:888-224-7312
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-25
Last Update Date:2023-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor