Healthcare Provider Details

I. General information

NPI: 1750561551
Provider Name (Legal Business Name): EYTAN S SALINGER LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/08/2007
Last Update Date: 01/26/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2805 LAS VEGAS CT SUITE B
LAS CRUCES NM
88007-4108
US

IV. Provider business mailing address

2805 LAS VEGAS CT SUITE B
LAS CRUCES NM
88007-4108
US

V. Phone/Fax

Practice location:
  • Phone: 575-522-5144
  • Fax: 575-522-5177
Mailing address:
  • Phone: 575-522-5144
  • Fax: 575-522-5177

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberC-08864
License Number StateNM

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier18677037
Identifier TypeMEDICAID
Identifier StateNM
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: