Healthcare Provider Details

I. General information

NPI: 1194730598
Provider Name (Legal Business Name): FERN SELZER PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/31/2006
Last Update Date: 01/15/2024
Certification Date: 01/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4010 MOORPARK AVE STE 118
SAN JOSE CA
95117-1804
US

IV. Provider business mailing address

4010 MOORPARK AVE STE 118
SAN JOSE CA
95117-1804
US

V. Phone/Fax

Practice location:
  • Phone: 831-475-9091
  • Fax:
Mailing address:
  • Phone: 831-475-9091
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPSY8906
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License NumberPSY8906
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: