Provider Demographics
NPI:1720013246
Name:SALEM, RONALD ELLIOTT (PSYD)
Entity Type:Individual
Prefix:DR
First Name:RONALD
Middle Name:ELLIOTT
Last Name:SALEM
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 1:1230 RIVER LN
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92706-1425
Mailing Address - Country:US
Mailing Address - Phone:714-543-4446
Mailing Address - Fax:714-543-4446
Practice Address - Street 1:1370 VALLEY VISTA DR
Practice Address - Street 2:SUITE 104
Practice Address - City:DIAMOND BAR
Practice Address - State:CA
Practice Address - Zip Code:91765-3911
Practice Address - Country:US
Practice Address - Phone:909-860-2166
Practice Address - Fax:909-860-5424
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY12527103TC0700X, 103TC2200X, 103TM1800X, 103T00000X, 103TP2701X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Not Answered103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
Not Answered103TM1800XBehavioral Health & Social Service ProvidersPsychologistIntellectual & Developmental Disabilities
Not Answered103T00000XBehavioral Health & Social Service ProvidersPsychologist
Not Answered103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup Psychotherapy