Provider Demographics
NPI:1144453440
Name:SALBERG, LORY
Entity type:Individual
Prefix:
First Name:LORY
Middle Name:
Last Name:SALBERG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1716
Mailing Address - Street 2:
Mailing Address - City:SISTERS
Mailing Address - State:OR
Mailing Address - Zip Code:97759
Mailing Address - Country:US
Mailing Address - Phone:530-570-0471
Mailing Address - Fax:
Practice Address - Street 1:3 GOVERNORS LN
Practice Address - Street 2:STE A
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95926-5503
Practice Address - Country:US
Practice Address - Phone:530-570-0471
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-02
Last Update Date:2019-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS258551041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical