Healthcare Provider Details

I. General information

NPI: 1285163543
Provider Name (Legal Business Name): SELIN SANTOS PSY.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2017
Last Update Date: 05/23/2022
Certification Date: 05/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3300 PGA BLVD STE 310
PALM BEACH GARDENS FL
33410-2810
US

IV. Provider business mailing address

2950 CLEVELAND CLINIC BLVD
WESTON FL
33331-3625
US

V. Phone/Fax

Practice location:
  • Phone: 561-983-6645
  • Fax:
Mailing address:
  • Phone: 954-659-5840
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TH0004X
TaxonomyHealth Psychologist
License NumberPY10595
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPY10595
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code103TH0100X
TaxonomyHealth Service Psychologist
License NumberPY10595
License Number StateFL
# 4
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPY10595
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: