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NPI Code Detail

MEDICARE: SELINA PHAN PSYD

MEDICARE: SELINA PHAN PSYD
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
1103TC0700XClinical Psychologist027800NY
2101Y00000XCounselor
3103TC0700XClinical PsychologistP131636NY

General Provider Information

NPI Number : 1548638364
Entity Type Code : Individual
Provider Name (Legal Business Name) : SELINA PHAN PSYD
Provider Business Mailing Address
First Line : 7901 BROADWAY # D10-38
Second Line :
City : ELMHURST
State : NY
Zip : 11373-1329
Country : US
Telephone Number : 718-334-3570
Fax Number : 718-334-5006
Provider Business Practice Location Address
First Line : 7901 BROADWAY # D10-38
Second Line :
City : ELMHURST
State : NY
Zip : 11373-1329
Country : US
Telephone Number : 718-334-3570
Fax Number : 718-334-5006
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/10/2015
Last Update Date : 12/09/2025

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Directions to “ SELINA PHAN PSYD” Practice Location

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