Provider Demographics
NPI:1386923183
Name:SEMEL, VICKI GRANET (PSYD)
Entity type:Individual
Prefix:
First Name:VICKI
Middle Name:GRANET
Last Name:SEMEL
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 S. LIVINGSTON AVE
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:LIVINGSTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07039-3932
Mailing Address - Country:US
Mailing Address - Phone:973-629-1006
Mailing Address - Fax:
Practice Address - Street 1:301 S. LIVINGSTON AVE
Practice Address - Street 2:2ND FLOOR
Practice Address - City:LIVINGSTON
Practice Address - State:NJ
Practice Address - Zip Code:07039-3932
Practice Address - Country:US
Practice Address - Phone:973-629-1006
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-10
Last Update Date:2011-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000372-1102L00000X
NJ35S100160600103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No102L00000XBehavioral Health & Social Service ProvidersPsychoanalyst