Provider Demographics
NPI:1952559791
Name:SALOM-BAIL, SHIRLEY RETUTA (LCSW, MSG)
Entity Type:Individual
Prefix:MS
First Name:SHIRLEY
Middle Name:RETUTA
Last Name:SALOM-BAIL
Suffix:
Gender:F
Credentials:LCSW, MSG
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:795 WILLOW ROAD
Mailing Address - Street 2:11NH
Mailing Address - City:MENLO PARK
Mailing Address - State:CA
Mailing Address - Zip Code:94025
Mailing Address - Country:US
Mailing Address - Phone:650-493-5000
Mailing Address - Fax:650-617-2616
Practice Address - Street 1:795 WILLOW RD
Practice Address - Street 2:11NH
Practice Address - City:MENLO PARK
Practice Address - State:CA
Practice Address - Zip Code:94025-2539
Practice Address - Country:US
Practice Address - Phone:650-493-5000
Practice Address - Fax:650-617-2616
Is Sole Proprietor?:No
Enumeration Date:2008-09-05
Last Update Date:2008-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS183061041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical