Provider Demographics
NPI:1891712345
Name:SALKIN, JEFFREY (PHD PSYCHOLOGY)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:
Last Name:SALKIN
Suffix:
Gender:M
Credentials:PHD PSYCHOLOGY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23360 CHAGRIN BLVD
Mailing Address - Street 2:STE 205
Mailing Address - City:BEACHWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44122
Mailing Address - Country:US
Mailing Address - Phone:440-460-4576
Mailing Address - Fax:216-360-7376
Practice Address - Street 1:23360 CHAGRIN BLVD
Practice Address - Street 2:STE 205
Practice Address - City:BEACHWOOD
Practice Address - State:OH
Practice Address - Zip Code:44122
Practice Address - Country:US
Practice Address - Phone:440-460-4576
Practice Address - Fax:216-360-7376
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-17
Last Update Date:2011-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4298103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SACP07351Medicare ID - Type Unspecified