NPIMap

Organization Active NPI

Wayside Youth & Family Support Network

  • Clinical Social Worker
  • Malden, MA
National Provider Identifier
1104977131
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
104386 Issued in MA
Legal business name
WAYSIDE YOUTH & FAMILY SUPPORT NETWORK
Practice address
22 Pleasant St
2205
Malden, MA 02148-5119
Phone
(781) 338-2640
Fax
(781) 338-2217
NPI assigned
Jan 16, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Ms. Andrea Salzman, LICSW
Title
Director of Home Base Program
Phone
(781) 891-0556

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social WorkerGroup: 193200000X MULTI-SPECIALTY GROUP 1041C0700X 104386 MA Primary

Addresses

Primary practice location

22 Pleasant St
2205
Malden, MA 02148-5119

Mailing address

22 Pleasant St
2205
Malden, MA 02148-5119
Phone (781) 338-2640

National Provider Directory

National Provider Directory
Tax ID family
Wayside Youth and Family Support Network8 organizations share this tax ID, including this one

Other organizations with this tax ID 7

Organizations that report the same tax identification number in the National Provider Directory.

Locations

22 Pleasant St
#2205
Malden, MA 02148
Phone (781) 338-2640

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1168905600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1104977131",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "22 PLEASANT ST",
            "address_2": "2205",
            "city": "MALDEN",
            "state": "MA",
            "postal_code": "021485119",
            "telephone_number": "781-338-2640",
            "fax_number": "781-338-2217"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "22 PLEASANT ST",
            "address_2": "2205",
            "city": "MALDEN",
            "state": "MA",
            "postal_code": "021485119",
            "telephone_number": "781-338-2640",
            "fax_number": "781-338-2217"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WAYSIDE YOUTH & FAMILY SUPPORT NETWORK",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-16",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "SALZMAN",
        "authorized_official_first_name": "ANDREA",
        "authorized_official_title_or_position": "DIRECTOR OF HOME BASE PROGRAM",
        "authorized_official_telephone_number": "781-891-0556",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "LICSW"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": "MA",
            "license": "104386",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Malden, MA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.