Provider Demographics
NPI:1255671558
Name:SALEM STATE UNIVERSITY
Entity Type:Organization
Organization Name:SALEM STATE UNIVERSITY
Other - Org Name:COUNSELING AND HEALTH SERVICES
Other - Org Type:Other Name
Authorized Official - Title/Position:ASSOCIATE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:L
Authorized Official - Last Name:DALY
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:978-542-6410
Mailing Address - Street 1:352 LAFAYETTE ST
Mailing Address - Street 2:COUNSELING AND HEALTH SERVICES
Mailing Address - City:SALEM
Mailing Address - State:MA
Mailing Address - Zip Code:01970-5348
Mailing Address - Country:US
Mailing Address - Phone:978-542-6410
Mailing Address - Fax:978-542-7121
Practice Address - Street 1:352 LAFAYETTE ST
Practice Address - Street 2:COUNSELING AND HEALTH SERVICES
Practice Address - City:SALEM
Practice Address - State:MA
Practice Address - Zip Code:01970-5348
Practice Address - Country:US
Practice Address - Phone:978-542-6410
Practice Address - Fax:978-542-7121
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COMMONWEALTH OF MASSACHUSETTS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-02-22
Last Update Date:2013-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1000XAmbulatory Health Care FacilitiesClinic/CenterStudent Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA80840-1174679898OtherNPI
MA80840-1881645380OtherNPI
MA80840-1124068663OtherNPI
MA80840-1801835392OtherNPI