Provider Demographics
NPI:1649427303
Name:STAHL SELINES, JACQUELINE FRANCES (PSYD)
Entity type:Individual
Prefix:DR
First Name:JACQUELINE
Middle Name:FRANCES
Last Name:STAHL SELINES
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:MS
Other - First Name:JACQUELINE
Other - Middle Name:FRANCES
Other - Last Name:STAHL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS
Mailing Address - Street 1:7 DEAN ST
Mailing Address - Street 2:
Mailing Address - City:TAUNTON
Mailing Address - State:MA
Mailing Address - Zip Code:02780-2725
Mailing Address - Country:US
Mailing Address - Phone:774-259-7534
Mailing Address - Fax:
Practice Address - Street 1:7 DEAN ST
Practice Address - Street 2:
Practice Address - City:TAUNTON
Practice Address - State:MA
Practice Address - Zip Code:02780-2725
Practice Address - Country:US
Practice Address - Phone:508-823-6899
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-08-25
Last Update Date:2015-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10155103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical