Individual
BRIAN W SELBY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHD
Contact information
Practice address
6 STATE ST, SUITE 208, BANGOR, ME 04401-5112
(207) 299-2442
Mailing address
6 STATE ST, SUITE 208, BANGOR, ME 04401-5112
(207) 299-2442
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
PS1017
ME
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
098303
ANTHEM LEGACY NUMBER
ME
05
—
333960099
—
ME
Enumeration date
06/13/2006
Last updated
04/15/2014
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