Basic Information
| Provider Information | |||||||||
| NPI: | 1710530191 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SALAZAR | ||||||||
| FirstName: | HERMION | ||||||||
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| Credential: | CASACT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 44 ABBEY LN UNIT 4111 | ||||||||
| Address2: | |||||||||
| City: | DANBURY | ||||||||
| State: | CT | ||||||||
| PostalCode: | 068105239 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 1914471625 | ||||||||
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| Practice Location | |||||||||
| Address1: | 21 OLD ROUTE 6 | ||||||||
| Address2: | |||||||||
| City: | CARMEL | ||||||||
| State: | NY | ||||||||
| PostalCode: | 105122107 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8452255202 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/24/2019 | ||||||||
| LastUpdateDate: | 06/11/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/11/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | 31691 | NY | Y | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) | 374U00000X | N | Nursing Service Related Providers | Home Health Aide |
ID Information
| ID | Type | State | Issuer | Description | 01420795 | 05 | NY | MEDICAID |