Healthcare Provider Details

I. General information

NPI: 1366549909
Provider Name (Legal Business Name): SELMA INGBER MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/17/2006
Last Update Date: 10/19/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

223 CHIEF JUSTICE CUSHING HWY STE 204
COHASSET MA
02025-1391
US

IV. Provider business mailing address

PO BOX 313
COHASSET MA
02025-0313
US

V. Phone/Fax

Practice location:
  • Phone: 781-383-0860
  • Fax: 781-383-1239
Mailing address:
  • Phone: 781-383-0860
  • Fax: 781-383-1239

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number101413
License Number StateMA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: