Provider Demographics
NPI:1407945223
Name:SILVA, COLLEEN A (LISW)
Entity Type:Individual
Prefix:
First Name:COLLEEN
Middle Name:A
Last Name:SILVA
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:801 E WASHINGTON ST
Mailing Address - Street 2:SUITE 150
Mailing Address - City:MEDINA
Mailing Address - State:OH
Mailing Address - Zip Code:44256-3335
Mailing Address - Country:US
Mailing Address - Phone:330-722-1069
Mailing Address - Fax:330-764-9712
Practice Address - Street 1:801 E WASHINGTON ST
Practice Address - Street 2:SUITE 150
Practice Address - City:MEDINA
Practice Address - State:OH
Practice Address - Zip Code:44256-3335
Practice Address - Country:US
Practice Address - Phone:330-722-1069
Practice Address - Fax:330-764-9712
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHIOOO81691041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical