Provider Demographics
NPI:1063664860
Name:MODESTO, SALVATORE SETH (LSW)
Entity Type:Individual
Prefix:MR
First Name:SALVATORE
Middle Name:SETH
Last Name:MODESTO
Suffix:
Gender:M
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3033 KUTZTOWN RD
Mailing Address - Street 2:SIDE 3
Mailing Address - City:READING
Mailing Address - State:PA
Mailing Address - Zip Code:19605-3415
Mailing Address - Country:US
Mailing Address - Phone:570-449-3703
Mailing Address - Fax:
Practice Address - Street 1:527 E LANCASTER AVE
Practice Address - Street 2:
Practice Address - City:SHILLINGTON
Practice Address - State:PA
Practice Address - Zip Code:19607-1364
Practice Address - Country:US
Practice Address - Phone:610-796-8110
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-10-13
Last Update Date:2008-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW126768104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker