Provider Demographics
NPI:1073168076
Name:SILVA, JESUS ANTHONY (LICSWA)
Entity Type:Individual
Prefix:MR
First Name:JESUS
Middle Name:ANTHONY
Last Name:SILVA
Suffix:
Gender:M
Credentials:LICSWA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3216 92ND PL SE
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98208-3001
Mailing Address - Country:US
Mailing Address - Phone:206-484-6300
Mailing Address - Fax:
Practice Address - Street 1:3330 MONTE VILLA PKWY
Practice Address - Street 2:
Practice Address - City:BOTHELL
Practice Address - State:WA
Practice Address - Zip Code:98021-8972
Practice Address - Country:US
Practice Address - Phone:425-408-6000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-06
Last Update Date:2019-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WASC607204791041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical