Healthcare Provider Details

I. General information

NPI: 1871418293
Provider Name (Legal Business Name): SELA MAE FERNANCE LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/13/2026
Last Update Date: 08/13/2026
Certification Date: 08/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

330 MARKET ST
HARTFORD CT
06120-2901
US

IV. Provider business mailing address

106 RAMBLER ST
BRISTOL CT
06010-3213
US

V. Phone/Fax

Practice location:
  • Phone: 860-761-7908
  • Fax:
Mailing address:
  • Phone: 860-681-4508
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number12501
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: