Individual provider Active NPI

Robert Selverstone, PH.D.

  • Psychologist
  • Westport, CT
National Provider Identifier
1083839401
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
PsychologistTaxonomy code 103T00000X
License
714 Issued in CT
Practice address
26 Imperial Ave
Westport, CT 06880-4301
Phone
(203) 226-0052
NPI assigned
Apr 13, 2007
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychologist 103T00000X 714 CT Primary

Addresses

Primary practice location

26 Imperial Ave
Westport, CT 06880-4301

Mailing address

26 Imperial Ave
Westport, CT 06880-4301
Phone (203) 226-0052

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CT
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20120106000302 CT Practitioner - Clinical Psychologist 2264608652 Practice locations: Westport, CT

Care Compare profile

Medicare Care Compare
Specialty
Clinical Psychologist
Education
New York University School of Medicine, 1971
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services

Practice addresses (Care Compare)

31 Bonnie Brook Rd
Westport, CT 06880-1505
Phone (203) 451-1089

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Philosophy

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1176422400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1083839401",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "26 IMPERIAL AVE",
            "city": "WESTPORT",
            "state": "CT",
            "postal_code": "068804301",
            "telephone_number": "203-226-0052"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "26 IMPERIAL AVE",
            "city": "WESTPORT",
            "state": "CT",
            "postal_code": "068804301",
            "telephone_number": "203-226-0052"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SELVERSTONE",
        "first_name": "ROBERT",
        "name_prefix": "Dr.",
        "credential": "PH.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-04-13",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "CT",
            "license": "714",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Westport, CT

Sources for this page

Verify at the official NPI Registry.