Provider Demographics
NPI:1225508229
Name:DICOVICH, SILVIA (LPC)
Entity Type:Individual
Prefix:
First Name:SILVIA
Middle Name:
Last Name:DICOVICH
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3241 MAIN ST STE B
Mailing Address - Street 2:
Mailing Address - City:STRATFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06614-4850
Mailing Address - Country:US
Mailing Address - Phone:203-500-6397
Mailing Address - Fax:203-383-4499
Practice Address - Street 1:3241 MAIN ST STE B
Practice Address - Street 2:
Practice Address - City:STRATFORD
Practice Address - State:CT
Practice Address - Zip Code:06614-4850
Practice Address - Country:US
Practice Address - Phone:203-500-6397
Practice Address - Fax:203-383-4499
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-03
Last Update Date:2024-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT003629101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004069985Medicaid