Provider Demographics
NPI:1144110677
Name:SALERNO, EVAN JOSEPH (MA)
Entity type:Individual
Prefix:
First Name:EVAN
Middle Name:JOSEPH
Last Name:SALERNO
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3623 ALTON PL NW
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20008-4219
Mailing Address - Country:US
Mailing Address - Phone:202-494-8413
Mailing Address - Fax:
Practice Address - Street 1:4530 WISCONSIN AVE NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20016-4627
Practice Address - Country:US
Practice Address - Phone:202-494-8413
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-07
Last Update Date:2025-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator