1508355082 NPI number — ADRIANA MELISSA SILVA LMSW

Table of content: ADRIANA MELISSA SILVA LMSW (NPI 1508355082)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1508355082 NPI number — ADRIANA MELISSA SILVA LMSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SILVA
Provider First Name:
ADRIANA
Provider Middle Name:
MELISSA
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LMSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SILVA-MADLON
Provider Other First Name:
ADRIANA
Provider Other Middle Name:
MELISSA
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1508355082
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/09/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
36 OWENS ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BRENTWOOD
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11717-6618
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
631-835-7641
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
320 CARLETON AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CENTRAL ISLIP
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11722-4506
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
631-663-4310
Provider Business Practice Location Address Fax Number:
631-439-4066
Provider Enumeration Date:
05/09/2018

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: 103TP2701X , with the licence number:  100995 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1528093242 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".




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