Provider Demographics
NPI:1780373225
Name:DURAND SALAVERRY, ROGER (MFT)
Entity type:Individual
Prefix:
First Name:ROGER
Middle Name:
Last Name:DURAND SALAVERRY
Suffix:
Gender:M
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1279 SAINT GEORGES AVE APT 7C
Mailing Address - Street 2:
Mailing Address - City:COLONIA
Mailing Address - State:NJ
Mailing Address - Zip Code:07067-3936
Mailing Address - Country:US
Mailing Address - Phone:848-250-2494
Mailing Address - Fax:
Practice Address - Street 1:1279 SAINT GEORGES AVE APT 7C
Practice Address - Street 2:
Practice Address - City:COLONIA
Practice Address - State:NJ
Practice Address - Zip Code:07067-3936
Practice Address - Country:US
Practice Address - Phone:848-250-2494
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-02
Last Update Date:2023-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37FA00036700106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist