Provider Demographics
NPI:1235515883
Name:KISS, SALLY (LICSW)
Entity Type:Individual
Prefix:MS
First Name:SALLY
Middle Name:
Last Name:KISS
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:455 SEA ST UNIT 1B
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:MA
Mailing Address - Zip Code:02169-2704
Mailing Address - Country:US
Mailing Address - Phone:617-396-4483
Mailing Address - Fax:617-687-8472
Practice Address - Street 1:455 SEA ST UNIT 1B
Practice Address - Street 2:
Practice Address - City:QUINCY
Practice Address - State:MA
Practice Address - Zip Code:02169-2704
Practice Address - Country:US
Practice Address - Phone:617-396-4483
Practice Address - Fax:617-687-8472
Is Sole Proprietor?:No
Enumeration Date:2015-08-05
Last Update Date:2023-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1222961041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical