Provider Demographics
NPI:1407355837
Name:FAVOTTO, SILVANA DANIELSKI
Entity Type:Individual
Prefix:
First Name:SILVANA
Middle Name:DANIELSKI
Last Name:FAVOTTO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:77 E MERRIMACK ST
Mailing Address - Street 2:
Mailing Address - City:LOWELL
Mailing Address - State:MA
Mailing Address - Zip Code:01852-1251
Mailing Address - Country:US
Mailing Address - Phone:978-349-4204
Mailing Address - Fax:978-221-6924
Practice Address - Street 1:77 E MERRIMACK ST
Practice Address - Street 2:
Practice Address - City:LOWELL
Practice Address - State:MA
Practice Address - Zip Code:01852-1251
Practice Address - Country:US
Practice Address - Phone:978-349-4204
Practice Address - Fax:978-221-6924
Is Sole Proprietor?:No
Enumeration Date:2018-02-12
Last Update Date:2018-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
MA101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health