Provider Demographics
NPI:1326841099
Name:NOAH, SALAM M
Entity type:Individual
Prefix:
First Name:SALAM
Middle Name:M
Last Name:NOAH
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6849 BRACE ST
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48228-3490
Mailing Address - Country:US
Mailing Address - Phone:619-312-9387
Mailing Address - Fax:
Practice Address - Street 1:6849 BRACE ST
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48228-3490
Practice Address - Country:US
Practice Address - Phone:619-312-9387
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-28
Last Update Date:2025-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician