Provider Demographics
NPI:1497092043
Name:SALVATORE, PATRICIA SUE (CADC)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:SUE
Last Name:SALVATORE
Suffix:
Gender:F
Credentials:CADC
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 462
Mailing Address - Street 2:
Mailing Address - City:OXFORD
Mailing Address - State:ME
Mailing Address - Zip Code:04270-0462
Mailing Address - Country:US
Mailing Address - Phone:207-650-6195
Mailing Address - Fax:
Practice Address - Street 1:45 RABBIT VALLEY RD
Practice Address - Street 2:
Practice Address - City:OXFORD
Practice Address - State:ME
Practice Address - Zip Code:04270-4225
Practice Address - Country:US
Practice Address - Phone:207-650-6195
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-01-15
Last Update Date:2013-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECAC5129101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)