Provider Demographics
NPI:1689872129
Name:NATIVIDAD, LISALINDA SALAS (MSW)
Entity Type:Individual
Prefix:
First Name:LISALINDA
Middle Name:SALAS
Last Name:NATIVIDAD
Suffix:
Gender:F
Credentials:MSW
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 22945
Mailing Address - Street 2:GUAM MAIN FACILITY
Mailing Address - City:BARRIGADA
Mailing Address - State:GU
Mailing Address - Zip Code:96921-2945
Mailing Address - Country:US
Mailing Address - Phone:671-477-5715
Mailing Address - Fax:
Practice Address - Street 1:222 E CHALAN SANTO PAPA STE 102
Practice Address - Street 2:REFLECTION CENTER
Practice Address - City:HAGATNA
Practice Address - State:GU
Practice Address - Zip Code:96910-5172
Practice Address - Country:US
Practice Address - Phone:671-477-5715
Practice Address - Fax:671-477-5714
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HILCSW-31661041C0700X
GUIMF-000069106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist