Healthcare Provider Details

I. General information

NPI: 1013152818
Provider Name (Legal Business Name): MS. CHRIS ELLEN SALONIA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/08/2008
Last Update Date: 12/08/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

82 SMITHFIELD AVE
MERIDEN CT
06451-2613
US

IV. Provider business mailing address

82 SMITHFIELD AVE
MERIDEN CT
06451-2613
US

V. Phone/Fax

Practice location:
  • Phone: 203-235-4864
  • Fax:
Mailing address:
  • Phone: 203-235-4864
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number03-629520
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: