Healthcare Provider Details

I. General information

NPI: 1982486841
Provider Name (Legal Business Name): ENA SELMANOVIC LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/16/2023
Last Update Date: 10/16/2023
Certification Date: 10/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2090 ADAM CLAYTON POWELL JR BLVD FL 4
NEW YORK NY
10027-4941
US

IV. Provider business mailing address

2110 FREDERICK DOUGLASS BLVD APT 3C
NEW YORK NY
10026-1637
US

V. Phone/Fax

Practice location:
  • Phone: 212-553-6708
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number121089
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: