Healthcare Provider Details

I. General information

NPI: 1992360184
Provider Name (Legal Business Name): SYLWIA MALGORZATA SALI BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/03/2019
Last Update Date: 04/07/2021
Certification Date: 04/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24 CHURCH ST APT 23
WATERTOWN MA
02472-3843
US

IV. Provider business mailing address

24 CHURCH ST APT 23
WATERTOWN MA
02472-3843
US

V. Phone/Fax

Practice location:
  • Phone: 781-215-4684
  • Fax:
Mailing address:
  • Phone: 781-215-4684
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License NumberLBA973
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code222Q00000X
TaxonomyDevelopmental Therapist
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: