Provider Demographics
NPI:1487631727
Name:SALOMONE, ALFRED (PSY D)
Entity Type:Individual
Prefix:
First Name:ALFRED
Middle Name:
Last Name:SALOMONE
Suffix:
Gender:M
Credentials:PSY D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1114
Mailing Address - Street 2:
Mailing Address - City:LAKEVILLE
Mailing Address - State:MA
Mailing Address - Zip Code:02347-1114
Mailing Address - Country:US
Mailing Address - Phone:508-763-9299
Mailing Address - Fax:508-763-9517
Practice Address - Street 1:966C PARK ST
Practice Address - Street 2:
Practice Address - City:STOUGHTON
Practice Address - State:MA
Practice Address - Zip Code:02072-3650
Practice Address - Country:US
Practice Address - Phone:781-341-3334
Practice Address - Fax:781-341-8141
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-28
Last Update Date:2012-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4895103T00000X, 103TC0700X, 103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
W05095Medicare ID - Type Unspecified