Provider Demographics
NPI:1952923690
Name:SALERNO, ANISSA (PMHNP)
Entity Type:Individual
Prefix:
First Name:ANISSA
Middle Name:
Last Name:SALERNO
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 PLAZA DR STE F
Mailing Address - Street 2:
Mailing Address - City:VESTAL
Mailing Address - State:NY
Mailing Address - Zip Code:13850-3640
Mailing Address - Country:US
Mailing Address - Phone:570-840-1289
Mailing Address - Fax:
Practice Address - Street 1:120 FOSTER ST
Practice Address - Street 2:
Practice Address - City:OLD FORGE
Practice Address - State:PA
Practice Address - Zip Code:18518-1406
Practice Address - Country:US
Practice Address - Phone:570-840-1289
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-16
Last Update Date:2023-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP022070363LP0808X
NYF405155-01363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health