Provider Demographics
NPI:1821665373
Name:SALOMON, MICHELINE (MSW)
Entity Type:Individual
Prefix:MRS
First Name:MICHELINE
Middle Name:
Last Name:SALOMON
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:MRS
Other - First Name:MICHELINE
Other - Middle Name:
Other - Last Name:SALOMON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW
Mailing Address - Street 1:121 WEBB DR STE 400
Mailing Address - Street 2:
Mailing Address - City:DAVENPORT
Mailing Address - State:FL
Mailing Address - Zip Code:33837-3904
Mailing Address - Country:US
Mailing Address - Phone:863-438-6806
Mailing Address - Fax:
Practice Address - Street 1:121 WEBB DR STE 400
Practice Address - Street 2:
Practice Address - City:DAVENPORT
Practice Address - State:FL
Practice Address - Zip Code:33837-3904
Practice Address - Country:US
Practice Address - Phone:863-438-6806
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-04
Last Update Date:2021-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1041C0700X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical