Provider Demographics
NPI:1821646340
Name:SANCHES DA SILVA, MARCIO (LSW, LCADC)
Entity Type:Individual
Prefix:
First Name:MARCIO
Middle Name:
Last Name:SANCHES DA SILVA
Suffix:
Gender:M
Credentials:LSW, LCADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:220 W JERSEY ST APT 12E
Mailing Address - Street 2:
Mailing Address - City:ELIZABETH
Mailing Address - State:NJ
Mailing Address - Zip Code:07202-1309
Mailing Address - Country:US
Mailing Address - Phone:973-634-6462
Mailing Address - Fax:
Practice Address - Street 1:25 BROAD ST FL 2
Practice Address - Street 2:
Practice Address - City:ELIZABETH
Practice Address - State:NJ
Practice Address - Zip Code:07201-2201
Practice Address - Country:US
Practice Address - Phone:908-906-7559
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-28
Last Update Date:2019-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SL06461900104100000X
NJ10248811041S0200X
NJ37LC00297100101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
No1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool