Provider Demographics
NPI:1750496162
Name:SALCEDO, ROBERT A (LCSW)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:A
Last Name:SALCEDO
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:219 ROUTE 66
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:CT
Mailing Address - Zip Code:06237-1420
Mailing Address - Country:US
Mailing Address - Phone:860-228-9033
Mailing Address - Fax:860-228-9033
Practice Address - Street 1:219 ROUTE 66
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:CT
Practice Address - Zip Code:06237-1420
Practice Address - Country:US
Practice Address - Phone:860-228-9033
Practice Address - Fax:860-228-9033
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0042421041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical