Provider Demographics
NPI:1922616515
Name:DASILVA, JENNIFER LINETH
Entity Type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:LINETH
Last Name:DASILVA
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 1:1401 NE 155TH TER
Mailing Address - Street 2:
Mailing Address - City:NORTH MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33162-5623
Mailing Address - Country:US
Mailing Address - Phone:786-458-3836
Mailing Address - Fax:
Practice Address - Street 1:16201 NE 13TH AVE # 4607
Practice Address - Street 2:
Practice Address - City:NORTH MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33162-4607
Practice Address - Country:US
Practice Address - Phone:786-955-6224
Practice Address - Fax:786-364-7244
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-20
Last Update Date:2021-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL19-99208106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician