Jill Ann Selbach, PH.D.

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

PY6375 Issued in FL

Practice address

3650 N Federal Hwy
Suite 215
Lighthouse Point, FL 33064-6649

Phone

(954) 782-6461

Fax

(954) 782-8389

NPI assigned

Mar 15, 2007

Last updated

Jul 8, 2007By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Opted out of Medicare

Yes, effective Oct 1, 2021 through Oct 1, 2027

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

State licenses

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Jill a. Selbach, PH.D., P.a.

  • Psychologist
  • Lighthouse Point, FL
  • NPI 1598033573
  Authorized official Same address or phone

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

{
    "created_epoch": "1173916800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1922132331",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3650 N FEDERAL HWY",
            "address_2": "SUITE 215",
            "city": "LIGHTHOUSE POINT",
            "state": "FL",
            "postal_code": "330646649",
            "telephone_number": "954-782-6461",
            "fax_number": "954-782-8389"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3650 N FEDERAL HWY",
            "address_2": "SUITE 215",
            "city": "LIGHTHOUSE POINT",
            "state": "FL",
            "postal_code": "330646649",
            "telephone_number": "954-782-6461",
            "fax_number": "954-782-8389"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SELBACH",
        "first_name": "JILL",
        "middle_name": "ANN",
        "name_prefix": "Dr.",
        "credential": "PH.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-03-15",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "FL",
            "license": "PY6375",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Clinical Psychologist in Lighthouse Point, FL
• Providers in Lighthouse Point, FL by specialty
• Clinical Psychologist in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.