Provider Demographics
NPI:1013073212
Name:SILVA, LAURA (MA, LICMHC)
Entity type:Individual
Prefix:MS
First Name:LAURA
Middle Name:
Last Name:SILVA
Suffix:
Gender:F
Credentials:MA, LICMHC
Other - Prefix:MS
Other - First Name:LAURA
Other - Middle Name:
Other - Last Name:SILVA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MA, LICMHC
Mailing Address - Street 1:262 TOM SWAMP RD
Mailing Address - Street 2:
Mailing Address - City:PETERSHAM
Mailing Address - State:MA
Mailing Address - Zip Code:01366-9615
Mailing Address - Country:US
Mailing Address - Phone:978-249-4109
Mailing Address - Fax:978-249-0997
Practice Address - Street 1:52 CEDAR ST
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01609-2134
Practice Address - Country:US
Practice Address - Phone:508-754-1406
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1469101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health