Provider Demographics
NPI:1922160142
Name:SILVIA, JENNIFER
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:SILVIA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:J
Other - Middle Name:SILVIA
Other - Last Name:MCCLURE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:16 MARTLAND AVE # 3
Mailing Address - Street 2:
Mailing Address - City:BROCKTON
Mailing Address - State:MA
Mailing Address - Zip Code:02301-1426
Mailing Address - Country:US
Mailing Address - Phone:508-468-0231
Mailing Address - Fax:
Practice Address - Street 1:16 MARTLAND AVE # 3
Practice Address - Street 2:
Practice Address - City:BROCKTON
Practice Address - State:MA
Practice Address - Zip Code:02301-1426
Practice Address - Country:US
Practice Address - Phone:508-468-0231
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA5589101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health