Healthcare Provider Details

I. General information

NPI: 1033921036
Provider Name (Legal Business Name): MARIAM SALAMI MHC-LP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/25/2025
Last Update Date: 01/25/2025
Certification Date: 01/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2460 VICTORY BLVD
STATEN ISLAND NY
10314-6612
US

IV. Provider business mailing address

14411 181ST PL
SPRINGFIELD GARDENS NY
11413-3216
US

V. Phone/Fax

Practice location:
  • Phone: 917-781-0041
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberP133629
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: