Healthcare Provider Details

I. General information

NPI: 1538670831
Provider Name (Legal Business Name): LAURA MARIE CISLER MSW, LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/13/2017
Last Update Date: 10/13/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

70 EVERETT AVE STE 515
CHELSEA MA
02150-2363
US

IV. Provider business mailing address

20 CHILD ST APT 1202
CAMBRIDGE MA
02141-1785
US

V. Phone/Fax

Practice location:
  • Phone: 617-466-6650
  • Fax:
Mailing address:
  • Phone: 219-871-2037
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number000223090
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: