| Organization Name: | WAYSIDE YOUTH & FAMILY SUPPORT NETWORK |
| NPI Number: | 1104977131 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | ANDREA SALZMAN (DIRECTOR OF HOME BASE PROGRAM) |
| Mailing Address: | 22 Pleasant St 2205 Malden |
| State: | MA US |
| Postal Code: | 021485119 |
| Phone Number: | 7813382640 |
| Fax Number: | 7813382217 |
| NPI Enumeration Date: | 01/16/2007 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 1041C0700X |
| License Number: | 104386 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MA |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Social Worker |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | A social worker who holds a master |