Provider Demographics
NPI:1770805723
Name:DIMARCO, SALVATORE A
Entity type:Individual
Prefix:
First Name:SALVATORE
Middle Name:A
Last Name:DIMARCO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4928 LEEWARD LN
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33312-5222
Mailing Address - Country:US
Mailing Address - Phone:954-579-4647
Mailing Address - Fax:
Practice Address - Street 1:4928 LEEWARD LN
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33312-5222
Practice Address - Country:US
Practice Address - Phone:954-579-4647
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-02-18
Last Update Date:2022-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist
No104100000XBehavioral Health & Social Service ProvidersSocial Worker