=====================================================
General NPI Number Information
=====================================================
NPI Number | 1366585697
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | NANCY SELL BYRON MSW
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/15/2007
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 44 SYCAMORE AVE
-----------------------------------------------------
City | LITTLE SILVER
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07739-1242
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 732-747-6548
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 236
-----------------------------------------------------
City | MONMOUTH BEACH
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07750-0236
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 732-747-6548
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | 44SC00007600
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------