Provider Demographics
NPI:1164493110
Name:BLEIBERG, SALLYE F (MSW)
Entity Type:Individual
Prefix:MS
First Name:SALLYE
Middle Name:F
Last Name:BLEIBERG
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 HARRIS ST
Mailing Address - Street 2:
Mailing Address - City:BELMONT
Mailing Address - State:MA
Mailing Address - Zip Code:02478-1918
Mailing Address - Country:US
Mailing Address - Phone:617-489-3843
Mailing Address - Fax:617-484-4459
Practice Address - Street 1:14 HARRIS ST
Practice Address - Street 2:
Practice Address - City:BELMONT
Practice Address - State:MA
Practice Address - Zip Code:02478-1918
Practice Address - Country:US
Practice Address - Phone:617-489-3843
Practice Address - Fax:617-484-4459
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-29
Last Update Date:2010-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1041981041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAP02353OtherBLUE CROSS/SHIELD
MAP02353Medicare ID - Type UnspecifiedPROVIDER #