Provider Demographics
NPI:1912506130
Name:WOLFEL, SELENA LUISA
Entity Type:Individual
Prefix:MS
First Name:SELENA
Middle Name:LUISA
Last Name:WOLFEL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:231 SMITH AVE SE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87102-4754
Mailing Address - Country:US
Mailing Address - Phone:505-273-1324
Mailing Address - Fax:
Practice Address - Street 1:231 SMITH AVE SE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87102-4754
Practice Address - Country:US
Practice Address - Phone:505-273-1324
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-19
Last Update Date:2020-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician