Provider Demographics
NPI:1568192292
Name:SALERNO, MARK ALLEN (CDCA)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:ALLEN
Last Name:SALERNO
Suffix:
Gender:M
Credentials:CDCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3225 SULLIVANT AVE
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43204-1837
Mailing Address - Country:US
Mailing Address - Phone:614-655-8956
Mailing Address - Fax:614-748-0569
Practice Address - Street 1:3225 SULLIVANT AVE
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43204-1837
Practice Address - Country:US
Practice Address - Phone:614-655-8956
Practice Address - Fax:614-748-0569
Is Sole Proprietor?:No
Enumeration Date:2022-06-15
Last Update Date:2022-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)