Provider Demographics
NPI:1013046481
Name:SELINGER, DIANE (PHD)
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:
Last Name:SELINGER
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 1:5225 OLD ORCHARD RD
Mailing Address - Street 2:
Mailing Address - City:SKOKIE
Mailing Address - State:IL
Mailing Address - Zip Code:60077-4405
Mailing Address - Country:US
Mailing Address - Phone:847-583-1849
Mailing Address - Fax:847-663-1022
Practice Address - Street 1:1330 SHERWOOD RD
Practice Address - Street 2:
Practice Address - City:GLENVIEW
Practice Address - State:IL
Practice Address - Zip Code:60025-2370
Practice Address - Country:US
Practice Address - Phone:847-583-1849
Practice Address - Fax:847-663-1022
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical