Healthcare Provider Details

I. General information

NPI: 1184669855
Provider Name (Legal Business Name): DR. MARIA LENI SELLA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/18/2006
Last Update Date: 03/25/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20600 EUREKA RD
TAYLOR MI
48180-5343
US

IV. Provider business mailing address

229 N SHELDON RD
PLYMOUTH MI
48170-1524
US

V. Phone/Fax

Practice location:
  • Phone: 734-285-8282
  • Fax:
Mailing address:
  • Phone: 313-278-4601
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number105130
License Number StateMI
# 3
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number6301009196
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: