Provider Demographics
NPI:1497729305
Name:SALERNO, JOHN A (PHD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:A
Last Name:SALERNO
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:56 SOUTH MAIN ST
Mailing Address - Street 2:STE A
Mailing Address - City:STOCKTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08559
Mailing Address - Country:US
Mailing Address - Phone:609-397-8585
Mailing Address - Fax:609-397-1907
Practice Address - Street 1:56 SOUTH MAIN ST
Practice Address - Street 2:STE A
Practice Address - City:STOCKTON
Practice Address - State:NJ
Practice Address - Zip Code:08559
Practice Address - Country:US
Practice Address - Phone:609-397-8585
Practice Address - Fax:609-397-1907
Is Sole Proprietor?:No
Enumeration Date:2006-02-15
Last Update Date:2007-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC01012000104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ133540Medicare PIN
S17092Medicare UPIN