Basic Information
| Provider Information | |||||||||
| NPI: | 1417423799 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SALVI | ||||||||
| FirstName: | KRISTEN | ||||||||
| MiddleName: | L | ||||||||
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| NameSuffix: | |||||||||
| Credential: | LCSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5730 EXECUTIVE DR STE 230 | ||||||||
| Address2: | |||||||||
| City: | CATONSVILLE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 212281762 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4104022379 | ||||||||
| FaxNumber: | 4104693085 | ||||||||
| Practice Location | |||||||||
| Address1: | 1 CEDAR CREST VILLAGE DR | ||||||||
| Address2: | |||||||||
| City: | POMPTON PLAINS | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 074442100 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9738313540 | ||||||||
| FaxNumber: | 9738313503 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/15/2018 | ||||||||
| LastUpdateDate: | 03/29/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/22/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 44SC06077900 | NJ | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical | 104100000X | 44SL06418000 | NJ | N | Behavioral Health & Social Service Providers | Social Worker |
ID Information
| ID | Type | State | Issuer | Description | 44SL06418000 | 01 | NJ | LSW LICENSE # | OTHER |