Holly Selepouchin

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

44SC058533900 Issued in NJ

Practice address

527 Hallowood Dr
East Stroudsburg, PA 18302-7728

Phone

(973) 670-6893

NPI assigned

Aug 27, 2019

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in NJ

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

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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

• Forge Medical Group, LLC

  • Psychiatry Physician
  • West Orange, NJ
  • NPI 1962175026
  Medicare reassignment NPD
• Mental Health Specialty Group PA

  • Mental Health Counselor
  • Durham, NC
  • NPI 1801472634

  PA

  Medicare reassignment NPD
• Forge Medical Group, LLC

  • Psychiatry Physician
  • White Plains, NY
  • NPI 1811561855
  NPD

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

{
    "created_epoch": "1566864000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1709510400000",
    "number": "1932757754",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "527 HALLOWOOD DR",
            "city": "EAST STROUDSBURG",
            "state": "PA",
            "postal_code": "183027728"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "527 HALLOWOOD DR",
            "city": "EAST STROUDSBURG",
            "state": "PA",
            "postal_code": "183027728",
            "telephone_number": "973-670-6893"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SELEPOUCHIN",
        "first_name": "HOLLY",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-08-27",
        "last_updated": "2024-03-04",
        "certification_date": "2024-03-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NJ",
            "license": "44SC058533900",
            "primary": true
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jillian Marie Seamon, A.T.C.
• Morgan Secoy
• Mayuri K Sedani, MD
• Mythili Seetharaman, MD
• Mursal Sekandari, MD
• Kierra Serb
• Arjinder Pal Singh Sethi, M.D.
• Robert John Sever, R.PH.
• Cornelia Sewell-Allen
• Carolina Sforza, MD

• Clinical Social Worker in East Stroudsburg, PA
• Providers in East Stroudsburg, PA by specialty
• Clinical Social Worker in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 4, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.