Provider Demographics
NPI:1902231897
Name:SALAS SILVA, MARISA (MSW)
Entity Type:Individual
Prefix:
First Name:MARISA
Middle Name:
Last Name:SALAS SILVA
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 1:3401 BEECH STREET
Mailing Address - Street 2:BLDG 949
Mailing Address - City:MCCLELLAN
Mailing Address - State:CA
Mailing Address - Zip Code:95652
Mailing Address - Country:US
Mailing Address - Phone:916-640-8050
Mailing Address - Fax:
Practice Address - Street 1:3401 BEECH STREET
Practice Address - Street 2:BLDG 949
Practice Address - City:MCCLELLAN
Practice Address - State:CA
Practice Address - Zip Code:95652
Practice Address - Country:US
Practice Address - Phone:916-640-8050
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-10
Last Update Date:2013-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker