Provider Demographics
NPI:1629525456
Name:SILVA, CICELY M
Entity Type:Individual
Prefix:
First Name:CICELY
Middle Name:M
Last Name:SILVA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:CICELY
Other - Middle Name:M
Other - Last Name:BONILLA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:15127 S 73RD AVE
Mailing Address - Street 2:SUITE G
Mailing Address - City:ORLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60462-4398
Mailing Address - Country:US
Mailing Address - Phone:800-361-6880
Mailing Address - Fax:708-845-5505
Practice Address - Street 1:1550 S STATE ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60605-7805
Practice Address - Country:US
Practice Address - Phone:800-361-6880
Practice Address - Fax:708-845-5505
Is Sole Proprietor?:No
Enumeration Date:2016-09-09
Last Update Date:2016-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178011834101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor