Provider Demographics
NPI:1235789975
Name:SALINAS, STEPHANIE ANGELA (MSW, LICSW)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:ANGELA
Last Name:SALINAS
Suffix:
Gender:F
Credentials:MSW, LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:124 HARVARD ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLINE
Mailing Address - State:MA
Mailing Address - Zip Code:02446-6478
Mailing Address - Country:US
Mailing Address - Phone:617-553-6513
Mailing Address - Fax:617-752-6767
Practice Address - Street 1:124 HARVARD ST
Practice Address - Street 2:
Practice Address - City:BROOKLINE
Practice Address - State:MA
Practice Address - Zip Code:02446-6478
Practice Address - Country:US
Practice Address - Phone:617-553-6513
Practice Address - Fax:617-752-6767
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-15
Last Update Date:2019-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA122067104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker