Provider Demographics
NPI:1134302714
Name:SILVA, IVANILDA (LCSW)
Entity Type:Individual
Prefix:MS
First Name:IVANILDA
Middle Name:
Last Name:SILVA
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2316 N INTERSTATE DR
Mailing Address - Street 2:
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73072-2942
Mailing Address - Country:US
Mailing Address - Phone:405-801-2817
Mailing Address - Fax:
Practice Address - Street 1:6051 N BROOKLINE AVE
Practice Address - Street 2:SUITE 112
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73112-4289
Practice Address - Country:US
Practice Address - Phone:405-810-0054
Practice Address - Fax:405-810-8977
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-06
Last Update Date:2016-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
104100000X
OKTEMP1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical