MEDICARE: SALEM PSYCHIATRIC ASSOCIATES PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	103TC0700X	Clinical Psychologist
2	103TM1800X	Intellectual & Developmental Disabilities Psychologist
3	104100000X	Social Worker
4	101YM0800X	Mental Health Counselor
5	1041C0700X	Clinical Social Worker

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	015466000	OTHER	OR	BLUE CROSS

General Provider Information

NPI Number	:	1912121526
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SALEM PSYCHIATRIC ASSOCIATES PC

Provider Business Mailing Address
First Line	:	821 SAGINAW ST S
Second Line	:
City	:	SALEM
State	:	OR
Zip	:	97302-4121
Country	:	US
Telephone Number	:	503-315-8646
Fax Number	:	503-798-9560

Provider Business Practice Location Address
First Line	:	821 SAGINAW ST S
Second Line	:
City	:	SALEM
State	:	OR
Zip	:	97302-4121
Country	:	US
Telephone Number	:	503-589-4046
Fax Number	:	503-362-9671

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	CAMILLE SOLEIL
Credential	:
Telephone Number	:	503-798-9541

Provider Enumeration Date	:	04/13/2007
Last Update Date	:	10/03/2017

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