Provider Demographics
NPI:1558433813
Name:SALVATORE, ELIZABETH J (CSW, LLP)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:J
Last Name:SALVATORE
Suffix:
Gender:F
Credentials:CSW, LLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3048 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49006-2956
Mailing Address - Country:US
Mailing Address - Phone:269-385-2784
Mailing Address - Fax:
Practice Address - Street 1:3048 W MAIN ST
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49006-2956
Practice Address - Country:US
Practice Address - Phone:269-385-2784
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010357001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI6131001OtherPHP
MIP208900780OtherBCBS
MI6131001OtherPHP
OP02300Medicare ID - Type Unspecified