| Doctor Name: | SELMA C MANGRUM |
| NPI Number: | 1003933904 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | |
| License Number: | LCS15263 |
| Business Practice Address: | 222 Paul Scannell Dr San Mateo, CA - 94402 |
| Business Phone Number: | 6503125234 |
| Business Fax Number: | 6503125305 |
| Mailing Address: | 222 Paul Scannell Dr, SAN MATEO |
| State: | CA |
| Postal Code: | 94402 |
| Phone Number: | 6503125234 |
| Fax Number: | 6503125305 |
| NPI Enumeration Date: | 03/23/2007 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 1041C0700X |
| License Number: | LCS15263 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CA |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Social Worker |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | A social worker who holds a master |