Provider Demographics
NPI:1841289253
Name:SALASKY, MARILYN G (LCSW)
Entity type:Individual
Prefix:MS
First Name:MARILYN
Middle Name:G
Last Name:SALASKY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:933 FIRST COLONIAL RD
Mailing Address - Street 2:#201
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23454-3172
Mailing Address - Country:US
Mailing Address - Phone:757-425-6612
Mailing Address - Fax:757-422-4078
Practice Address - Street 1:933 FIRST COLONIAL RD
Practice Address - Street 2:#201
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23454-3172
Practice Address - Country:US
Practice Address - Phone:757-425-6612
Practice Address - Fax:757-422-4078
Is Sole Proprietor?:No
Enumeration Date:2005-10-18
Last Update Date:2008-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040003271041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
800000114Medicare ID - Type Unspecified