Provider Demographics
NPI:1598203465
Name:SALCIDO NEGRETE, JAVIER RICRADO
Entity type:Individual
Prefix:
First Name:JAVIER RICRADO
Middle Name:
Last Name:SALCIDO NEGRETE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:255 GRAPEVINE RD
Mailing Address - Street 2:
Mailing Address - City:WENHAM
Mailing Address - State:MA
Mailing Address - Zip Code:01984-1813
Mailing Address - Country:US
Mailing Address - Phone:917-768-1966
Mailing Address - Fax:
Practice Address - Street 1:255 GRAPEVINE RD
Practice Address - Street 2:
Practice Address - City:WENHAM
Practice Address - State:MA
Practice Address - Zip Code:01984-1813
Practice Address - Country:US
Practice Address - Phone:917-768-1966
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-10
Last Update Date:2017-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor