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General NPI Number Information
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NPI Number | 1114557741
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Entity Type | Individual
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Provider Name | SELINA GRANT
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Gender | Female
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Dates
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Enumeration Date | 01/23/2020
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Last Update Date | 11/27/2023
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Provider Practice Location Address
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Address Line | 408 ELEANOR ST
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City | SCHENECTADY
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State | NY
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Zip | 12306-3122
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Country | US
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Telephone | 518-464-6309
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Fax |
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Provider Business Mailing Address
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Address Line | 348 BROADWAY
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City | MENANDS
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State | NY
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Zip | 12204-2715
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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