1184999443 NPI number — MARISSA SILVESTRO LMFT,MFT,BA

Table of content: MARISSA SILVESTRO LMFT,MFT,BA (NPI 1184999443)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1184999443 NPI number — MARISSA SILVESTRO LMFT,MFT,BA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SILVESTRO
Provider First Name:
MARISSA
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LMFT,MFT,BA
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
DIGANGI
Provider Other First Name:
MARISSA
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
LMFT
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1184999443
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/18/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1187 QUEEN ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SOUTHINGTON
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06489-1266
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
203-518-6747
Provider Business Mailing Address Fax Number:
203-490-4242

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1187 QUEEN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SOUTHINGTON
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06489-1266
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
203-518-6747
Provider Business Practice Location Address Fax Number:
203-490-4242
Provider Enumeration Date:
03/19/2012

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 106H00000X , with the licence number:  1611 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 060669107 . This is a "UBH/OXFORD FREEDOM-LIBERTY WELLMORE GRP/FACILITY" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 060669107 . This is a "ANTHEM BCBS OF CT WELLMORE GRP/FACILITY" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 060669107 . This is a "HEALTHYCT WELLMORE GRP/FACILITY" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: PENDING . This is a "MHN TRICARENORTH" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 060669107 . This is a "UBH/UNITED HEALTHCARE WELLMORE GRP/FACILITY" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 12659252 . This is a "CAQH" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 4679887 . This is a "CIGNA BEHAVIORAL HEALTH- WELLMORE" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 9951843 . This is a "AETNA BEHAVIORAL HEALTH" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 004392020 , issued by the state of ( CT ) . This identifiers is of the category "MEDICAID".
  • Identifier: PENDING . This is a "MHN MANAGED HEALTH NETWORK" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: D339123-141 E MAIN . This is a "BEACON HEALTH STRATEGIES" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 060669107 . This is a "UBH/CONNECTICARE WELLMORE GRP/FACILITY" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 060669107 . This is a "OPTUM BEHAVIORAL HEALTH/UBH WELLMORE GRP/FACILITY" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".




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