Provider Demographics
NPI:1811233166
Name:SAN SALVADOR, DONNA (MA, NCC)
Entity Type:Individual
Prefix:MS
First Name:DONNA
Middle Name:
Last Name:SAN SALVADOR
Suffix:
Gender:F
Credentials:MA, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:923 DEL PRADO BLVD S
Mailing Address - Street 2:SUITE 205
Mailing Address - City:CAPE CORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33990-3652
Mailing Address - Country:US
Mailing Address - Phone:239-826-8347
Mailing Address - Fax:239-242-6389
Practice Address - Street 1:923 DEL PRADO BLVD S
Practice Address - Street 2:SUITE 205
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33990-3652
Practice Address - Country:US
Practice Address - Phone:239-826-8347
Practice Address - Fax:239-242-6389
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-13
Last Update Date:2023-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH14116101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health