MEDICARE: MR. FRANK RICHARD SALCIDO LICENSED ED PSYCH

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC1900X	Counseling Psychologist	LEP 1535	CA
2	103TC2200X	Clinical Child & Adolescent Psychologist	LEP 1535	CA

General Provider Information

NPI Number	:	1932369881
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. FRANK RICHARD SALCIDO LICENSED ED PSYCH

Provider Business Mailing Address
First Line	:	300 W CHURCH ST
Second Line	:	125 E MORRISON AVE
City	:	SANTYA MARIA
State	:	CA
Zip	:	93454
Country	:	US
Telephone Number	:	805-452-3400
Fax Number	:	805-925-9634

Provider Business Practice Location Address
First Line	:	125 E MORRISON AVE
Second Line	:
City	:	SANTA MARIA
State	:	CA
Zip	:	93454-6619
Country	:	US
Telephone Number	:	805-452-3400
Fax Number	:	805-925-9634

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/13/2008
Last Update Date	:	06/13/2008

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