Provider Demographics
NPI:1043104763
Name:SILVA, LISSETTE ESTEFANIA
Entity type:Individual
Prefix:MRS
First Name:LISSETTE
Middle Name:ESTEFANIA
Last Name:SILVA
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:LISSETTE
Other - Middle Name:E
Other - Last Name:SILVA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1891 STOCKHOLM ST
Mailing Address - Street 2:
Mailing Address - City:RIDGEWOOD
Mailing Address - State:NY
Mailing Address - Zip Code:11385-1349
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:465 GRAND STREET
Practice Address - Street 2:FLOOR 2
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10002-4800
Practice Address - Country:US
Practice Address - Phone:212-420-1999
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-06
Last Update Date:2025-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY737849823171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator