Healthcare Provider Details

I. General information

NPI: 1063634020
Provider Name (Legal Business Name): MARIE SALVEMINI LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/02/2007
Last Update Date: 08/21/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 SHAWS CV
NEW LONDON CT
06320-4902
US

IV. Provider business mailing address

1 SHAWS CV
NEW LONDON CT
06320-4902
US

V. Phone/Fax

Practice location:
  • Phone: 860-447-8304
  • Fax: 860-443-8720
Mailing address:
  • Phone: 860-447-8304
  • Fax: 860-443-8720

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number608
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number0012299
License Number StateCT
# 3
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number1299
License Number StateCT
# 4
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number66799
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: