Basic Information
Provider Information | |||||||||
NPI: | 1619087442 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | SALAFIA | ||||||||
FirstName: | MARIA | ||||||||
MiddleName: | L | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 105 WEBSTER ST STE 8 | ||||||||
Address2: |   | ||||||||
City: | HANOVER | ||||||||
State: | MA | ||||||||
PostalCode: | 023391227 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7817546545 | ||||||||
FaxNumber: |   | ||||||||
Practice Location | |||||||||
Address1: | 105 WEBSTER ST STE 8 | ||||||||
Address2: |   | ||||||||
City: | HANOVER | ||||||||
State: | MA | ||||||||
PostalCode: | 023391227 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7817546545 | ||||||||
FaxNumber: |   | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 08/30/2006 | ||||||||
LastUpdateDate: | 09/08/2016 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 364SP0808X | 206530 | MA | N |   | Physician Assistants & Advanced Practice Nursing Providers | Clinical Nurse Specialist | Psych/Mental Health | 363LP0808X | 206530 | MA | Y |   | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Psych/Mental Health |
ID Information
ID | Type | State | Issuer | Description | 83-04664 | 01 | MA | EVERCARE | OTHER | 408414 | 01 | MA | TUFTS | OTHER | PN0727 | 01 | MA | BLUE SHIELD | OTHER | 0327107 | 05 | MA |   | MEDICAID |