Provider Demographics
NPI:1790853794
Name:BRICENO, SALOME L (MSW LCSW)
Entity Type:Individual
Prefix:MS
First Name:SALOME
Middle Name:L
Last Name:BRICENO
Suffix:
Gender:F
Credentials:MSW LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 HAMDEN CIRCLE
Mailing Address - Street 2:APT 2
Mailing Address - City:QUINCY
Mailing Address - State:MA
Mailing Address - Zip Code:02170-2014
Mailing Address - Country:US
Mailing Address - Phone:617-543-6478
Mailing Address - Fax:
Practice Address - Street 1:15A BOLTON PLACE
Practice Address - Street 2:
Practice Address - City:BROCKTON
Practice Address - State:MA
Practice Address - Zip Code:02301-5316
Practice Address - Country:US
Practice Address - Phone:508-427-4383
Practice Address - Fax:508-584-4328
Is Sole Proprietor?:No
Enumeration Date:2006-11-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MALCSW2137191041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical