Provider Demographics
NPI:1457569394
Name:SALONER, MICHELE (PHD)
Entity Type:Individual
Prefix:
First Name:MICHELE
Middle Name:
Last Name:SALONER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 EL CAPITAN DR
Mailing Address - Street 2:
Mailing Address - City:SAN RAFAEL
Mailing Address - State:CA
Mailing Address - Zip Code:94903-1003
Mailing Address - Country:US
Mailing Address - Phone:415-884-2131
Mailing Address - Fax:415-884-0371
Practice Address - Street 1:690 DE LONG AVE
Practice Address - Street 2:SUITE 150
Practice Address - City:NOVATO
Practice Address - State:CA
Practice Address - Zip Code:94945-3359
Practice Address - Country:US
Practice Address - Phone:415-884-2131
Practice Address - Fax:415-884-0371
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-21
Last Update Date:2013-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY11542103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAOPL115420Medicare ID - Type Unspecified