Provider Demographics
NPI:1720752488
Name:SALEMA, EMILY ROSE (PSYD)
Entity Type:Individual
Prefix:DR
First Name:EMILY
Middle Name:ROSE
Last Name:SALEMA
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 JUBILEE DR
Mailing Address - Street 2:
Mailing Address - City:CLARKSBORO
Mailing Address - State:NJ
Mailing Address - Zip Code:08020-1013
Mailing Address - Country:US
Mailing Address - Phone:856-981-2996
Mailing Address - Fax:
Practice Address - Street 1:21 JUBILEE DR
Practice Address - Street 2:
Practice Address - City:CLARKSBORO
Practice Address - State:NJ
Practice Address - Zip Code:08020-1013
Practice Address - Country:US
Practice Address - Phone:856-981-2996
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-05
Last Update Date:2022-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10435103T00000X
PAPS019425103T00000X
FLPY10376103T00000X
NJ35SI00586200103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist