Provider Demographics
NPI:1154340354
Name:SELTZER, ROBERT JOEL (PH D)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:JOEL
Last Name:SELTZER
Suffix:
Gender:M
Credentials:PH D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6353 CENTER DRIVE
Mailing Address - Street 2:STE 204
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23502
Mailing Address - Country:US
Mailing Address - Phone:757-461-3313
Mailing Address - Fax:757-461-8363
Practice Address - Street 1:6353 CENTER DRIVE
Practice Address - Street 2:STE 204
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23502
Practice Address - Country:US
Practice Address - Phone:757-461-3313
Practice Address - Fax:757-461-8363
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2011-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810000886103T00000X, 103TC0700X, 103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA007733453Medicaid
680000137Medicare ID - Type Unspecified