Provider Demographics
NPI:1841350899
Name:SALAM PSYCHIATRIC SERVICES, P.L.C
Entity type:Organization
Organization Name:SALAM PSYCHIATRIC SERVICES, P.L.C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:SABA
Authorized Official - Middle Name:MAHEEN
Authorized Official - Last Name:SALAM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:802-246-0781
Mailing Address - Street 1:20 TECHNOLOGY DRI
Mailing Address - Street 2:# 9
Mailing Address - City:BRATTLEBORO
Mailing Address - State:VT
Mailing Address - Zip Code:05301
Mailing Address - Country:US
Mailing Address - Phone:802-246-0781
Mailing Address - Fax:802-246-0742
Practice Address - Street 1:20 TECHNOLOGY DRIVE
Practice Address - Street 2:# 9
Practice Address - City:BRATTLEBORO
Practice Address - State:VT
Practice Address - Zip Code:05301
Practice Address - Country:US
Practice Address - Phone:802-246-0781
Practice Address - Fax:802-246-0742
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-11
Last Update Date:2010-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT42-00103312084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VTSALA00069122OtherBCBSVT GROUP NUMBER
VTSALA00069122OtherBCBSVT GROUP NUMBER