Provider Demographics
NPI:1912996570
Name:SALVO, ALICIA (PHD)
Entity Type:Individual
Prefix:DR
First Name:ALICIA
Middle Name:
Last Name:SALVO
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29 LOCUST PL
Mailing Address - Street 2:
Mailing Address - City:MANHASSET
Mailing Address - State:NY
Mailing Address - Zip Code:11030-1823
Mailing Address - Country:US
Mailing Address - Phone:917-771-2721
Mailing Address - Fax:
Practice Address - Street 1:81 LOUDEN AVE
Practice Address - Street 2:
Practice Address - City:AMITYVILLE
Practice Address - State:NY
Practice Address - Zip Code:11701-2736
Practice Address - Country:US
Practice Address - Phone:917-771-2721
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-17
Last Update Date:2018-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY014271103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02086533Medicaid
NYG400061805Medicare PIN