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General NPI Number Information
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NPI Number | 1285935189
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Entity Type | Organization
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Legal Business Name | CHAYA SELESNY
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Dates
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Enumeration Date | 11/09/2010
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Last Update Date | 11/09/2010
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Provider Practice Location Address
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Address Line | 23135 LAUREL VALLEY ST
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City | SOUTHFIELD
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State | MI
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Zip | 48034-2012
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Country | US
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Telephone | 248-231-2488
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Fax |
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Provider Business Mailing Address
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Address Line | 25131 RIDGE CLIFF DR
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City | SOUTHFIELD
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State | MI
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Zip | 48075-2022
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Country | US
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Telephone | 248-231-2488
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Fax |
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Authorized Official
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Title or Position | CLINICAL SOCIAL WORKER
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Name | MRS. CHAYA SELESNY
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Credential | LMSW
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Telephone | 248-231-2488
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 6801078038
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License Number State | MI
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