Provider Demographics
NPI:1386011914
Name:SALLEY, EMORY (LCSW, LCADC)
Entity Type:Individual
Prefix:
First Name:EMORY
Middle Name:
Last Name:SALLEY
Suffix:
Gender:F
Credentials:LCSW, LCADC
Other - Prefix:
Other - First Name:EMORY
Other - Middle Name:
Other - Last Name:CABRERA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW, LCADC
Mailing Address - Street 1:29 LINDEN ST
Mailing Address - Street 2:APARTMENT 311
Mailing Address - City:HACKENSACK
Mailing Address - State:NJ
Mailing Address - Zip Code:07601-8207
Mailing Address - Country:US
Mailing Address - Phone:347-739-8901
Mailing Address - Fax:
Practice Address - Street 1:29 LINDEN ST
Practice Address - Street 2:APARTMENT 311
Practice Address - City:HACKENSACK
Practice Address - State:NJ
Practice Address - Zip Code:07601-8207
Practice Address - Country:US
Practice Address - Phone:347-739-8901
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-31
Last Update Date:2015-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37LCOO202300101YA0400X
NJ44SC055424001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)