Provider Demographics
NPI:1366107252
Name:SALVINO, JESSICA NICOLE (LGPC)
Entity type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:NICOLE
Last Name:SALVINO
Suffix:
Gender:F
Credentials:LGPC
Other - Prefix:MS
Other - First Name:JESSICA
Other - Middle Name:NICOLE
Other - Last Name:CARLS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:709 S DEAN ST
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21224-4312
Mailing Address - Country:US
Mailing Address - Phone:240-362-6465
Mailing Address - Fax:
Practice Address - Street 1:7600 YORK RD
Practice Address - Street 2:
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21204-7500
Practice Address - Country:US
Practice Address - Phone:410-740-8066
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-04
Last Update Date:2023-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLGP12103101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health