Provider Demographics
NPI:1225645492
Name:SALVATORE, MICHELLE ELENORE
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:ELENORE
Last Name:SALVATORE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55A S MEADOWOOD DR
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19711-6755
Mailing Address - Country:US
Mailing Address - Phone:302-454-3400
Mailing Address - Fax:
Practice Address - Street 1:55A S MEADOWOOD DR
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19711-6755
Practice Address - Country:US
Practice Address - Phone:302-454-3400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-30
Last Update Date:2020-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DE106063103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool