Provider Demographics
NPI:1164987558
Name:SALAMON, SAMUEL ISAAC (PSYD)
Entity Type:Individual
Prefix:DR
First Name:SAMUEL
Middle Name:ISAAC
Last Name:SALAMON
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7409 SW CAPITOL HWY STE 202
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97219-2432
Mailing Address - Country:US
Mailing Address - Phone:732-730-7179
Mailing Address - Fax:
Practice Address - Street 1:7409 SW CAPITOL HWY
Practice Address - Street 2:SUITE 202
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97219
Practice Address - Country:US
Practice Address - Phone:503-468-4630
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-10
Last Update Date:2021-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD06011103TC0700X
OR3200103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical