Provider Demographics
NPI:1184968067
Name:LAMOTTE, SELENA A (DSW, LCSW, C-ACYFSW)
Entity type:Individual
Prefix:DR
First Name:SELENA
Middle Name:A
Last Name:LAMOTTE
Suffix:
Gender:F
Credentials:DSW, LCSW, C-ACYFSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10568 LONGLEAF LN
Mailing Address - Street 2:
Mailing Address - City:WELLINGTON
Mailing Address - State:FL
Mailing Address - Zip Code:33414-9398
Mailing Address - Country:US
Mailing Address - Phone:561-469-9670
Mailing Address - Fax:561-634-3861
Practice Address - Street 1:10568 LONGLEAF LN
Practice Address - Street 2:
Practice Address - City:WELLINGTON
Practice Address - State:FL
Practice Address - Zip Code:33414
Practice Address - Country:US
Practice Address - Phone:561-469-9670
Practice Address - Fax:561-634-3861
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-16
Last Update Date:2024-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW110991041C0700X, 1041C0700X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL007968500Medicaid