Healthcare Provider Details

I. General information

NPI: 1689872129
Provider Name (Legal Business Name): LISALINDA SALAS NATIVIDAD MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/05/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

222 E CHALAN SANTO PAPA STE 102 REFLECTION CENTER
HAGATNA GU
96910-5172
US

IV. Provider business mailing address

PO BOX 22945 GUAM MAIN FACILITY
BARRIGADA GU
96921-2945
US

V. Phone/Fax

Practice location:
  • Phone: 671-477-5715
  • Fax: 671-477-5714
Mailing address:
  • Phone: 671-477-5715
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW-3166
License Number StateHI
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberIMF-000069
License Number StateGU

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: