Healthcare Provider Details

I. General information

NPI: 1114979721
Provider Name (Legal Business Name): MELINDA S SALOMON PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/16/2006
Last Update Date: 02/09/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

360 MT AUBURN STREET
CAMBRIDGE MA
02138
US

IV. Provider business mailing address

131 FORBUSH MILL RD
BOLTON MA
01740-1245
US

V. Phone/Fax

Practice location:
  • Phone: 774-312-3334
  • Fax:
Mailing address:
  • Phone: 774-312-3334
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TA0400X
TaxonomyAddiction (Substance Use Disorder) Psychologist
License Number8463
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code103TA0700X
TaxonomyAdult Development & Aging Psychologist
License Number8463
License Number StateMA
# 3
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number8463
License Number StateMA
# 4
Primary TaxonomyN
Taxonomy Code103TR0400X
TaxonomyRehabilitation Psychologist
License Number8463
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: