Provider Demographics
NPI:1598177842
Name:SILVA, ROCHELLE
Entity Type:Individual
Prefix:
First Name:ROCHELLE
Middle Name:
Last Name:SILVA
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 1:75 CHRISTOPHER ST
Mailing Address - Street 2:
Mailing Address - City:DORCHESTER
Mailing Address - State:MA
Mailing Address - Zip Code:02122-1206
Mailing Address - Country:US
Mailing Address - Phone:857-264-0965
Mailing Address - Fax:
Practice Address - Street 1:75 CHRISTOPHER ST
Practice Address - Street 2:
Practice Address - City:DORCHESTER
Practice Address - State:MA
Practice Address - Zip Code:02122-1206
Practice Address - Country:US
Practice Address - Phone:857-264-0965
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-05-21
Last Update Date:2014-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1303295Medicaid
MAM18463OtherBLUE CROSS BLUE SHIELD
MA1307576Medicaid
MAY10086Medicare PIN