Provider Demographics
NPI:1306090576
Name:E. JEANNE SALEMI LCSW
Entity type:Organization
Organization Name:E. JEANNE SALEMI LCSW
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:E.
Authorized Official - Middle Name:JEANNE
Authorized Official - Last Name:SALEMI
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:757-306-4232
Mailing Address - Street 1:641 LYNNHAVEN PKWY
Mailing Address - Street 2:SUITE 204
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23452-7307
Mailing Address - Country:US
Mailing Address - Phone:757-306-4232
Mailing Address - Fax:757-306-4235
Practice Address - Street 1:641 LYNNHAVEN PKWY
Practice Address - Street 2:SUITE 204
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23452-7307
Practice Address - Country:US
Practice Address - Phone:757-306-4232
Practice Address - Fax:757-306-4235
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-13
Last Update Date:2008-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040012841041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA008914508Medicaid
095507OtherANTHEM
VA085899OtherSENTARA
031581OtherVALUE OPTIONS
VA800000732Medicare PIN