Provider Demographics
NPI:1508355082
Name:SILVA, ADRIANA MELISSA (LMSW)
Entity Type:Individual
Prefix:
First Name:ADRIANA
Middle Name:MELISSA
Last Name:SILVA
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:ADRIANA
Other - Middle Name:MELISSA
Other - Last Name:SILVA-MADLON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:36 OWENS ST
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:NY
Mailing Address - Zip Code:11717-6618
Mailing Address - Country:US
Mailing Address - Phone:631-835-7641
Mailing Address - Fax:
Practice Address - Street 1:320 CARLETON AVE
Practice Address - Street 2:
Practice Address - City:CENTRAL ISLIP
Practice Address - State:NY
Practice Address - Zip Code:11722-4506
Practice Address - Country:US
Practice Address - Phone:631-663-4310
Practice Address - Fax:631-439-4066
Is Sole Proprietor?:No
Enumeration Date:2018-05-09
Last Update Date:2018-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY100995103TP2701X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup Psychotherapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1528093242Medicaid