Provider Demographics
NPI:1043896939
Name:SILVA, MARTA L
Entity Type:Individual
Prefix:MS
First Name:MARTA
Middle Name:L
Last Name:SILVA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:222 TONGESS DRIVE
Mailing Address - Street 2:MEMC
Mailing Address - City:SITKA
Mailing Address - State:AK
Mailing Address - Zip Code:99835
Mailing Address - Country:US
Mailing Address - Phone:907-966-8611
Mailing Address - Fax:
Practice Address - Street 1:222 TONGESS DRIVE
Practice Address - Street 2:MEMC
Practice Address - City:SITKA
Practice Address - State:AK
Practice Address - Zip Code:99835-9983
Practice Address - Country:US
Practice Address - Phone:907-966-8818
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-22
Last Update Date:2021-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK106S00000XMedicaid