Basic Information
| Provider Information | |||||||||
| NPI: | 1205929759 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SALADA | ||||||||
| FirstName: | RICHARD | ||||||||
| MiddleName: | MARTIN | ||||||||
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| Credential: | LMHC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1370 NIAGARA FALLS BLVD | ||||||||
| Address2: | |||||||||
| City: | TONAWANDA | ||||||||
| State: | NY | ||||||||
| PostalCode: | 14150 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7168333708 | ||||||||
| FaxNumber: | 7168333711 | ||||||||
| Practice Location | |||||||||
| Address1: | 1370 NIAGARA FALLS BLVD | ||||||||
| Address2: | |||||||||
| City: | TONAWANDA | ||||||||
| State: | NY | ||||||||
| PostalCode: | 14150 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7168333708 | ||||||||
| FaxNumber: | 7168333711 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/02/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101Y00000X | 002896 | NY | Y | Behavioral Health & Social Service Providers | Counselor |
No ID Information.