Provider Demographics
NPI:1194244152
Name:SALERNO, ALEXANDRIA GRAZIA (PSYD)
Entity type:Individual
Prefix:
First Name:ALEXANDRIA
Middle Name:GRAZIA
Last Name:SALERNO
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 HARGER RD STE 600
Mailing Address - Street 2:
Mailing Address - City:OAK BROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60523-1820
Mailing Address - Country:US
Mailing Address - Phone:630-571-5750
Mailing Address - Fax:
Practice Address - Street 1:1200 HARGER RD STE 600
Practice Address - Street 2:
Practice Address - City:OAK BROOK
Practice Address - State:IL
Practice Address - Zip Code:60523-1820
Practice Address - Country:US
Practice Address - Phone:630-571-5750
Practice Address - Fax:630-571-5751
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-11
Last Update Date:2020-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225C00000X, 390200000X
IL071.010241103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
No225C00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation CounselorGroup - Single Specialty
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program