Healthcare Provider Details

I. General information

NPI: 1326382342
Provider Name (Legal Business Name): RYAN SELZER LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/15/2012
Last Update Date: 02/05/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

348 13TH ST SUITE 203
BROOKLYN NY
11215-6177
US

IV. Provider business mailing address

348 13TH ST SUITE 203
BROOKLYN NY
11215-6177
US

V. Phone/Fax

Practice location:
  • Phone: 718-788-5101
  • Fax:
Mailing address:
  • Phone: 718-788-5101
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberSW129556
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number086829
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number087855
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: