Healthcare Provider Details

I. General information

NPI: 1821948654
Provider Name (Legal Business Name): SELENE PSYCHIATRY, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/31/2026
Last Update Date: 01/31/2026
Certification Date: 01/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102 PARTRIDGE ST
WEST ROXBURY MA
02132-3617
US

IV. Provider business mailing address

102 PARTRIDGE ST
WEST ROXBURY MA
02132-3617
US

V. Phone/Fax

Practice location:
  • Phone: 860-990-7262
  • Fax:
Mailing address:
  • Phone: 860-990-7262
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. STEPHANIE FAGBEMI
Title or Position: MANAGING MEMBER
Credential: MD
Phone: 860-990-7262