Provider Demographics
NPI:1750689667
Name:SELINGER, AGNIESZKA (MA)
Entity type:Individual
Prefix:
First Name:AGNIESZKA
Middle Name:
Last Name:SELINGER
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3504 28TH AVE
Mailing Address - Street 2:ASTORIA
Mailing Address - City:ASTORIA
Mailing Address - State:NY
Mailing Address - Zip Code:11103-4665
Mailing Address - Country:US
Mailing Address - Phone:631-965-1044
Mailing Address - Fax:
Practice Address - Street 1:8460 123RD ST
Practice Address - Street 2:KEW GARDENS
Practice Address - City:KEW GARDENS
Practice Address - State:NY
Practice Address - Zip Code:11415-3305
Practice Address - Country:US
Practice Address - Phone:718-441-0166
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-03-02
Last Update Date:2014-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY020034103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0020034OtherLICENSE