Provider Demographics
NPI:1033157680
Name:SALANT, STACEY LEE (PHD)
Entity Type:Individual
Prefix:DR
First Name:STACEY
Middle Name:LEE
Last Name:SALANT
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1604 HILLTOP WEST SHOPPING CTR STE 215
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23451-6196
Mailing Address - Country:US
Mailing Address - Phone:757-351-4650
Mailing Address - Fax:757-932-5432
Practice Address - Street 1:1604 HILLTOP WEST SHOPPING CTR STE 215
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23451-6196
Practice Address - Country:US
Practice Address - Phone:757-351-4650
Practice Address - Fax:757-932-5432
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-04
Last Update Date:2020-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002560103TC0700X
VA0810003374103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT680001672Medicare ID - Type UnspecifiedMEDICARE