Provider Demographics
NPI:1346406204
Name:SALVADOR, MARIA FATIMA (MA)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:FATIMA
Last Name:SALVADOR
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:MARIA
Other - Middle Name:F
Other - Last Name:SALVADOR
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:490 N MAIN ST
Mailing Address - Street 2:SUITE 2
Mailing Address - City:RANDOLPH
Mailing Address - State:MA
Mailing Address - Zip Code:02368-3741
Mailing Address - Country:US
Mailing Address - Phone:781-963-1800
Mailing Address - Fax:781-963-1818
Practice Address - Street 1:490 N MAIN ST
Practice Address - Street 2:SUITE 2
Practice Address - City:RANDOLPH
Practice Address - State:MA
Practice Address - Zip Code:02368-3741
Practice Address - Country:US
Practice Address - Phone:781-963-1800
Practice Address - Fax:781-963-1818
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-31
Last Update Date:2011-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA9314103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical