Provider Demographics
NPI:1326659095
Name:SILVA, JONHATHAN JOSE
Entity Type:Individual
Prefix:
First Name:JONHATHAN
Middle Name:JOSE
Last Name:SILVA
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 1:76 JUSTICE HILL RD
Mailing Address - Street 2:
Mailing Address - City:STERLING
Mailing Address - State:MA
Mailing Address - Zip Code:01564-2035
Mailing Address - Country:US
Mailing Address - Phone:410-484-2792
Mailing Address - Fax:
Practice Address - Street 1:207 AUTHORITY DR
Practice Address - Street 2:
Practice Address - City:FITCHBURG
Practice Address - State:MA
Practice Address - Zip Code:01420-6044
Practice Address - Country:US
Practice Address - Phone:978-696-5115
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-14
Last Update Date:2020-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician