Provider Demographics
NPI:1063044543
Name:SILECCHIA, VITO
Entity Type:Individual
Prefix:
First Name:VITO
Middle Name:
Last Name:SILECCHIA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 WOODLAND DR
Mailing Address - Street 2:
Mailing Address - City:BAYPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11705-2021
Mailing Address - Country:US
Mailing Address - Phone:631-472-7491
Mailing Address - Fax:
Practice Address - Street 1:17 WOODLAND DR
Practice Address - Street 2:
Practice Address - City:BAYPORT
Practice Address - State:NY
Practice Address - Zip Code:11705-2021
Practice Address - Country:US
Practice Address - Phone:631-472-7491
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-12
Last Update Date:2020-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000492-01103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst