Provider Demographics
NPI:1568797298
Name:SALOMONE, KATHLEEN (EDD)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:
Last Name:SALOMONE
Suffix:
Gender:F
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:264 N MAIN ST
Mailing Address - Street 2:SUITE 15
Mailing Address - City:E LONGMEADOW
Mailing Address - State:MA
Mailing Address - Zip Code:01028-1815
Mailing Address - Country:US
Mailing Address - Phone:413-218-8159
Mailing Address - Fax:
Practice Address - Street 1:264 N MAIN ST
Practice Address - Street 2:SUITE 15
Practice Address - City:E LONGMEADOW
Practice Address - State:MA
Practice Address - Zip Code:01028-1815
Practice Address - Country:US
Practice Address - Phone:413-218-8159
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-10-14
Last Update Date:2012-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103T00000X
MA7910101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health