MEDICARE: SALENA KING CARUSO PHD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103T00000X	Psychologist	PS1407	ME

General Provider Information

NPI Number	:	1275164303
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SALENA KING CARUSO PHD

Provider Business Mailing Address
First Line	:	25 WILLIAMS ST
Second Line	:
City	:	HAMPDEN
State	:	ME
Zip	:	04444-1607
Country	:	US
Telephone Number	:	207-745-6901
Fax Number	:

Provider Business Practice Location Address
First Line	:	108 MAIN RD S STE A
Second Line	:
City	:	HAMPDEN
State	:	ME
Zip	:	04444-1204
Country	:	US
Telephone Number	:	207-862-3372
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/28/2020
Last Update Date	:	01/28/2020

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