1447383153 NPI number — MRS. TINA MARIE SILVER LCSW

Table of content: MRS. TINA MARIE SILVER LCSW (NPI 1447383153)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1447383153 NPI number — MRS. TINA MARIE SILVER LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SILVER
Provider First Name:
TINA
Provider Middle Name:
MARIE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LCSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1447383153
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/23/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
BOX 328 CONNECTIONS COUNSELING AND WELLNESS CENTER LLC
Provider Second Line Business Mailing Address:
163 BOSTON POST RD SUITES 3 & 4
Provider Business Mailing Address City Name:
WATERFORD
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06385
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
860-444-8774
Provider Business Mailing Address Fax Number:
860-444-8776

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
163 BOSTON POST RD
Provider Second Line Business Practice Location Address:
SUITES 3 & 4 CONNECTIONS COUNSELING AND WELLNESS CENTE
Provider Business Practice Location Address City Name:
WATERFORD
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06385
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
860-444-8774
Provider Business Practice Location Address Fax Number:
860-444-8776
Provider Enumeration Date:
03/13/2007

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: 1041C0700X , with the licence number:  005434 , 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: 004264397 , issued by the state of ( CT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 140005434CT01 . This is a "BCBS" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".