Provider Demographics
NPI:1518204940
Name:SALGADO, JUANITA (LCSW)
Entity Type:Individual
Prefix:
First Name:JUANITA
Middle Name:
Last Name:SALGADO
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13350 W COLONIAL DR
Mailing Address - Street 2:STE 340
Mailing Address - City:WINTER GARDEN
Mailing Address - State:FL
Mailing Address - Zip Code:34787-3977
Mailing Address - Country:US
Mailing Address - Phone:910-279-9525
Mailing Address - Fax:407-926-0209
Practice Address - Street 1:6900 S ORANGE BLOSSOM TRL STE 402
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32809
Practice Address - Country:US
Practice Address - Phone:407-894-8894
Practice Address - Fax:407-894-8893
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-04
Last Update Date:2019-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X
FLSW146521041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1518204940Medicaid