Provider Demographics
NPI:1801856505
Name:SALAS, JESUS ALBERTO (PSYD)
Entity Type:Individual
Prefix:MR
First Name:JESUS
Middle Name:ALBERTO
Last Name:SALAS
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1251 S CEDAR CREST BLVD
Mailing Address - Street 2:SUITE 211D
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18103-6205
Mailing Address - Country:US
Mailing Address - Phone:610-432-5066
Mailing Address - Fax:610-432-0973
Practice Address - Street 1:1251 S CEDAR CREST BLVD
Practice Address - Street 2:SUITE 211D
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18103-6205
Practice Address - Country:US
Practice Address - Phone:610-432-5066
Practice Address - Fax:610-432-0973
Is Sole Proprietor?:No
Enumeration Date:2006-03-25
Last Update Date:2007-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS015605103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA50053661OtherCAPITAL BLUE CROSS
PASA1785849OtherBLUE SHIELD INS. CO.
PA50053661OtherCAPITAL BLUE CROSS