Provider Demographics
NPI:1043591423
Name:SALAL, VICTORIA A (MSW, LICSW)
Entity type:Individual
Prefix:
First Name:VICTORIA
Middle Name:A
Last Name:SALAL
Suffix:
Gender:F
Credentials:MSW, LICSW
Other - Prefix:
Other - First Name:VICTORIA
Other - Middle Name:A
Other - Last Name:JONES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW, LICSW
Mailing Address - Street 1:PO BOX 5803
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01101-5803
Mailing Address - Country:US
Mailing Address - Phone:413-222-1536
Mailing Address - Fax:
Practice Address - Street 1:117 PARK AVE STE 201A
Practice Address - Street 2:
Practice Address - City:WEST SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01089-3371
Practice Address - Country:US
Practice Address - Phone:413-732-7677
Practice Address - Fax:413-732-7688
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-30
Last Update Date:2024-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1153681041C0700X
101YP1600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral