Provider Demographics
NPI:1053939520
Name:BOYD, SELENE GURBUZ (MSW)
Entity type:Individual
Prefix:
First Name:SELENE
Middle Name:GURBUZ
Last Name:BOYD
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:416 LIME AVE
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90802-2635
Mailing Address - Country:US
Mailing Address - Phone:562-343-3615
Mailing Address - Fax:
Practice Address - Street 1:2390 E ORANGEWOOD AVE STE 300
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92806-6138
Practice Address - Country:US
Practice Address - Phone:714-453-7480
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-10
Last Update Date:2020-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
950291041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty