Provider Demographics
NPI:1720608201
Name:SALISBURY, KATHY M (PHD)
Entity Type:Individual
Prefix:MS
First Name:KATHY
Middle Name:M
Last Name:SALISBURY
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:MS
Other - First Name:KATHRYN
Other - Middle Name:M
Other - Last Name:SALISBURY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:19 PENTECOST ST
Mailing Address - Street 2:
Mailing Address - City:BRANFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06405-4821
Mailing Address - Country:US
Mailing Address - Phone:917-379-3350
Mailing Address - Fax:
Practice Address - Street 1:129 CHURCH ST
Practice Address - Street 2:
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06510-2026
Practice Address - Country:US
Practice Address - Phone:917-379-3350
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-24
Last Update Date:2020-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001372101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional