Provider Demographics
NPI:1578629440
Name:SALON, RONALD MARK (MSW)
Entity Type:Individual
Prefix:MR
First Name:RONALD
Middle Name:MARK
Last Name:SALON
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:235 GARTH RD
Mailing Address - Street 2:APT.E3B
Mailing Address - City:SCARSDALE
Mailing Address - State:NY
Mailing Address - Zip Code:10583-3917
Mailing Address - Country:US
Mailing Address - Phone:914-725-7636
Mailing Address - Fax:
Practice Address - Street 1:3630 HILL BLVD
Practice Address - Street 2:SUITE 204
Practice Address - City:JEFFERSON VALLEY
Practice Address - State:NY
Practice Address - Zip Code:10535-1502
Practice Address - Country:US
Practice Address - Phone:914-962-1931
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR012263101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYN09532Medicare ID - Type Unspecified