Provider Demographics
NPI:1689694820
Name:SALTER-MOSS, KAREN M (PHD)
Entity Type:Individual
Prefix:DR
First Name:KAREN
Middle Name:M
Last Name:SALTER-MOSS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 W 1ST ST
Mailing Address - Street 2:SUITE 214
Mailing Address - City:CLAREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:91711-4736
Mailing Address - Country:US
Mailing Address - Phone:909-624-6005
Mailing Address - Fax:909-498-9443
Practice Address - Street 1:250 W 1ST ST
Practice Address - Street 2:SUITE 214
Practice Address - City:CLAREMONT
Practice Address - State:CA
Practice Address - Zip Code:91711-4736
Practice Address - Country:US
Practice Address - Phone:909-624-6005
Practice Address - Fax:909-498-9443
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-20
Last Update Date:2010-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 12514103TR0400X, 103G00000X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TR0400XBehavioral Health & Social Service ProvidersPsychologistRehabilitation
No103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACP12514Medicare ID - Type UnspecifiedMEDICARE