Individual
GREGG SELKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PH.D.
Contact information
Practice address
593 EDDY ST, POB 430, PROVIDENCE, RI 02903-4923
(401) 444-4500
(401) 444-6643
Mailing address
593 EDDY ST, POTTER 3, PROVIDENCE, RI 02903-4923
(401) 444-4318
(401) 444-6573
Taxonomy
Speciality
Code
Description
License number
State
103G00000X
Clinical Neuropsychologist
Primary
PS01024
RI
103TC0700X
Clinical Psychologist
PS01024
RI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PS01024
STATE LICENSE
RI
Enumeration date
07/10/2007
Last updated
02/05/2013
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