=====================================================
General NPI Number Information
=====================================================
NPI Number | 1982634150
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SALVATORE MARTONE LCSW
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/04/2006
-----------------------------------------------------
Last Update Date | 08/31/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 145 PEPPER TREE HILL LN
-----------------------------------------------------
City | SOUTHBURY
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06488-2340
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 203-510-2079
-----------------------------------------------------
Fax | 410-861-6262
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 145 PEPPER TREE HILL LN
-----------------------------------------------------
City | SOUTHBURY
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06488-2340
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 203-510-2079
-----------------------------------------------------
Fax | 410-861-6262
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | 001168
-----------------------------------------------------
License Number State | CT
-----------------------------------------------------