Provider Demographics
NPI:1043307044
Name:SOLOMON, KAYLA (LICSW)
Entity type:Individual
Prefix:
First Name:KAYLA
Middle Name:
Last Name:SOLOMON
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 ROUNDHOUSE PLZ
Mailing Address - Street 2:SUITE 203
Mailing Address - City:NORTHAMPTON
Mailing Address - State:MA
Mailing Address - Zip Code:01060-3545
Mailing Address - Country:US
Mailing Address - Phone:413-584-7722
Mailing Address - Fax:888-411-8532
Practice Address - Street 1:1 ROUNDHOUSE PLZ
Practice Address - Street 2:SUITE 203
Practice Address - City:NORTHAMPTON
Practice Address - State:MA
Practice Address - Zip Code:01060-3545
Practice Address - Country:US
Practice Address - Phone:413-584-7722
Practice Address - Fax:888-411-8532
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-10
Last Update Date:2012-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10277171041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
SOP20582Medicare ID - Type Unspecified