MEDICARE: DR. JOAN SELBY PSY.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	4505	MA
2	103TS0200X	School Psychologist	169861	MA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	W04428	OTHER	MA	B/CB/S MA PROVIDER#

General Provider Information

NPI Number	:	1356459622
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOAN SELBY PSY.D.

Provider Business Mailing Address
First Line	:	24 NORWOOD AVE
Second Line	:
City	:	MANCHESTER
State	:	MA
Zip	:	01944-1508
Country	:	US
Telephone Number	:	978-526-8391
Fax Number	:

Provider Business Practice Location Address
First Line	:	24 NORWOOD AVE
Second Line	:
City	:	MANCHESTER
State	:	MA
Zip	:	01944-1508
Country	:	US
Telephone Number	:	978-526-8391
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/28/2006
Last Update Date	:	09/11/2025

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