Provider Demographics
NPI:1184657074
Name:DEGIROLAMO, SILVIA (PSYD)
Entity Type:Individual
Prefix:
First Name:SILVIA
Middle Name:
Last Name:DEGIROLAMO
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:204 SHADY PORCH CT
Mailing Address - Street 2:
Mailing Address - City:HOLLY SPRINGS
Mailing Address - State:NC
Mailing Address - Zip Code:27540-7338
Mailing Address - Country:US
Mailing Address - Phone:203-445-3435
Mailing Address - Fax:
Practice Address - Street 1:2817 REILLY ST
Practice Address - Street 2:
Practice Address - City:FORT BRAGG
Practice Address - State:NC
Practice Address - Zip Code:28310-1931
Practice Address - Country:US
Practice Address - Phone:910-745-7070
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2018-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA8482103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1320815Medicaid
MA1319833Medicaid
MA221868OtherUGS
MA221845OtherUGS
MAM21400Medicare Oscar/Certification
MAOTH000Medicare UPIN
MA1319833Medicaid
MAW06625Medicare UPIN