Provider Demographics
NPI:1609418953
Name:TOSO, SALLY A (LICSW)
Entity Type:Individual
Prefix:
First Name:SALLY
Middle Name:A
Last Name:TOSO
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:SALLY
Other - Middle Name:A
Other - Last Name:MURPHY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:624 SELBY AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55104-6614
Mailing Address - Country:US
Mailing Address - Phone:651-293-1000
Mailing Address - Fax:651-291-1001
Practice Address - Street 1:624 SELBY AVE
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55104-6614
Practice Address - Country:US
Practice Address - Phone:651-293-1000
Practice Address - Fax:651-291-1001
Is Sole Proprietor?:No
Enumeration Date:2019-10-08
Last Update Date:2019-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN244201041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical