Healthcare Provider Details

I. General information

NPI: 1063262913
Provider Name (Legal Business Name): SELENI HOUSE FOUNDATION, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/25/2024
Last Update Date: 04/03/2024
Certification Date: 04/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

122 E 64TH ST
NEW YORK NY
10065-7358
US

IV. Provider business mailing address

122 E 64TH ST
NEW YORK NY
10065-7358
US

V. Phone/Fax

Practice location:
  • Phone: 212-939-7200
  • Fax:
Mailing address:
  • Phone: 212-939-7200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: SEEMA BAJAJ
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 212-939-7200