Provider Demographics
NPI:1679663033
Name:DIOGUARDI, SALVATORE MICHAEL (MSW)
Entity Type:Individual
Prefix:MR
First Name:SALVATORE
Middle Name:MICHAEL
Last Name:DIOGUARDI
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 1:41625 PARK AVENUE
Mailing Address - Street 2:SUITE 300
Mailing Address - City:LEONARDTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:20650
Mailing Address - Country:US
Mailing Address - Phone:301-475-3208
Mailing Address - Fax:301-862-3208
Practice Address - Street 1:41625 PARK AVENUE
Practice Address - Street 2:SUITE 300
Practice Address - City:LEONARDTOWN
Practice Address - State:MD
Practice Address - Zip Code:20650
Practice Address - Country:US
Practice Address - Phone:301-475-3208
Practice Address - Fax:301-862-1567
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-13
Last Update Date:2008-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD133571041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD567 SMedicare UPIN