MEDICARE: STEFANIE SALOME

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103K00000X	Behavior Analyst

General Provider Information

NPI Number	:	1407159528
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEFANIE SALOME

Provider Business Mailing Address
First Line	:	109 OAK ST STE G10
Second Line	:
City	:	NEWTON
State	:	MA
Zip	:	02464-1492
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	109 OAK ST STE G10
Second Line	:
City	:	NEWTON
State	:	MA
Zip	:	02464-1492
Country	:	US
Telephone Number	:	617-467-4523
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/10/2010
Last Update Date	:	05/08/2011

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Directions to “ STEFANIE SALOME ” Practice Location

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