Provider Demographics
NPI:1275597825
Name:SALATA, JANE ANN (LICSW)
Entity Type:Individual
Prefix:
First Name:JANE
Middle Name:ANN
Last Name:SALATA
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:PO BOX 46
Mailing Address - Street 2:
Mailing Address - City:LENOXDALE
Mailing Address - State:MA
Mailing Address - Zip Code:01242-0046
Mailing Address - Country:US
Mailing Address - Phone:413-446-7026
Mailing Address - Fax:413-637-8074
Practice Address - Street 1:16 POST RD
Practice Address - Street 2:
Practice Address - City:LENOX
Practice Address - State:MA
Practice Address - Zip Code:01240-2342
Practice Address - Country:US
Practice Address - Phone:413-637-0034
Practice Address - Fax:413-637-8074
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1050021041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
32412OtherHEALTH NEW ENGLAND
P03330OtherBLUE CROSS BLUE SHIELD
P22229Medicare ID - Type Unspecified