Provider Demographics
NPI:1013097138
Name:SELZNICK, RICHARD (PHD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:
Last Name:SELZNICK
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 FEDERAL ST # 200
Mailing Address - Street 2:
Mailing Address - City:CAMDEN
Mailing Address - State:NJ
Mailing Address - Zip Code:08103-1088
Mailing Address - Country:US
Mailing Address - Phone:856-356-4924
Mailing Address - Fax:
Practice Address - Street 1:110 MARTER AVE STE 506
Practice Address - Street 2:
Practice Address - City:MOORESTOWN
Practice Address - State:NJ
Practice Address - Zip Code:08057
Practice Address - Country:US
Practice Address - Phone:856-763-4900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-16
Last Update Date:2019-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJS102390103TB0200X
NJ35SI00239000103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ3K5451OtherHEALTHNET, INC
NJ41023OtherAETNA US HEALTHCARE
NJ2030815OtherUNITED HEALTHCARE
NJ26129OtherUNIVERSITY HEALTH PLAN
NJ6859801Medicaid
NJ91193OtherAMERIGROUP
NJP2704835OtherOXFORD
NJ6859801Medicaid