Provider Demographics
NPI:1568821445
Name:DA SILVA, JURACI MARIA (MA, PHD)
Entity Type:Individual
Prefix:DR
First Name:JURACI
Middle Name:MARIA
Last Name:DA SILVA
Suffix:
Gender:F
Credentials:MA, PHD
Other - Prefix:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:68 LAIGHT ST
Mailing Address - Street 2:APT 7
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10013-2034
Mailing Address - Country:US
Mailing Address - Phone:516-987-4200
Mailing Address - Fax:800-297-0976
Practice Address - Street 1:68 LAIGHT ST
Practice Address - Street 2:APT 7
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10013-2034
Practice Address - Country:US
Practice Address - Phone:516-987-4200
Practice Address - Fax:800-297-0976
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-19
Last Update Date:2016-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY018633-1103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYLIC 018633-1OtherWC AUTH NO S18633-8W RATE CODE PSY