Provider Demographics
NPI:1861615817
Name:SELEY, MARGARITA L (PSYD)
Entity type:Individual
Prefix:
First Name:MARGARITA
Middle Name:L
Last Name:SELEY
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3665 OAK KNOLL BLVD
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94605-4457
Mailing Address - Country:US
Mailing Address - Phone:510-567-8834
Mailing Address - Fax:
Practice Address - Street 1:2940 SUMMIT ST
Practice Address - Street 2:SUITE 2A
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94609-3405
Practice Address - Country:US
Practice Address - Phone:510-893-2001
Practice Address - Fax:510-893-2027
Is Sole Proprietor?:No
Enumeration Date:2007-04-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSB31133103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical