MEDICARE: GRETCHEN LOUISE SELBY LMSW

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	104100000X	Social Worker	M-057777	NM

General Provider Information

NPI Number	:	1457396137
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GRETCHEN LOUISE SELBY LMSW

Provider Business Mailing Address
First Line	:	1505 15TH ST
Second Line	:
City	:	LOS ALAMOS
State	:	NM
Zip	:	87544-3000
Country	:	US
Telephone Number	:	505-662-3264
Fax Number	:	505-662-9707

Provider Business Practice Location Address
First Line	:	1505 15TH ST
Second Line	:
City	:	LOS ALAMOS
State	:	NM
Zip	:	87544-3000
Country	:	US
Telephone Number	:	505-662-3264
Fax Number	:	505-662-9707

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

Provider Enumeration Date	:	06/18/2006
Last Update Date	:	07/08/2007

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Directions to “ GRETCHEN LOUISE SELBY LMSW” Practice Location

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