Healthcare Provider Details

I. General information

NPI: 1306308143
Provider Name (Legal Business Name): YOLANDA SELTZER LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/02/2019
Last Update Date: 04/02/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

860 MELROSE AVE
BRONX NY
10451-4443
US

IV. Provider business mailing address

27 SPEED ST
BRENTWOOD NY
11717-6411
US

V. Phone/Fax

Practice location:
  • Phone: 917-473-6996
  • Fax: 718-504-4551
Mailing address:
  • Phone: 917-509-1278
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number105288
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: