Provider Demographics
NPI:1629209135
Name:SALVUCCI, CAITRIN PERRY (NP)
Entity Type:Individual
Prefix:
First Name:CAITRIN
Middle Name:PERRY
Last Name:SALVUCCI
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:CAITRIN
Other - Middle Name:E
Other - Last Name:PERRY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:56 CHESTNUT HILL AVE
Mailing Address - Street 2:
Mailing Address - City:BRIGHTON
Mailing Address - State:MA
Mailing Address - Zip Code:02135-3398
Mailing Address - Country:US
Mailing Address - Phone:617-299-9889
Mailing Address - Fax:781-558-9191
Practice Address - Street 1:56 CHESTNUT HILL AVE STE 104A
Practice Address - Street 2:
Practice Address - City:BRIGHTON
Practice Address - State:MA
Practice Address - Zip Code:02135-3398
Practice Address - Country:US
Practice Address - Phone:617-299-9889
Practice Address - Fax:781-558-9191
Is Sole Proprietor?:No
Enumeration Date:2009-07-31
Last Update Date:2021-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN284377363LP0808X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1320858OtherGROUP FCHC MEDICAID #