Provider Demographics
NPI:1184999443
Name:SILVESTRO, MARISSA (LMFT,MFT,BA)
Entity type:Individual
Prefix:
First Name:MARISSA
Middle Name:
Last Name:SILVESTRO
Suffix:
Gender:F
Credentials:LMFT,MFT,BA
Other - Prefix:
Other - First Name:MARISSA
Other - Middle Name:
Other - Last Name:DIGANGI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMFT
Mailing Address - Street 1:1187 QUEEN ST
Mailing Address - Street 2:
Mailing Address - City:SOUTHINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06489-1266
Mailing Address - Country:US
Mailing Address - Phone:203-518-6747
Mailing Address - Fax:203-490-4242
Practice Address - Street 1:1187 QUEEN ST
Practice Address - Street 2:
Practice Address - City:SOUTHINGTON
Practice Address - State:CT
Practice Address - Zip Code:06489-1266
Practice Address - Country:US
Practice Address - Phone:203-518-6747
Practice Address - Fax:203-490-4242
Is Sole Proprietor?:No
Enumeration Date:2012-03-19
Last Update Date:2023-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT1611106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT060669107OtherUBH/OXFORD FREEDOM-LIBERTY WELLMORE GRP/FACILITY
CT060669107OtherANTHEM BCBS OF CT WELLMORE GRP/FACILITY
CT060669107OtherHEALTHYCT WELLMORE GRP/FACILITY
CTPENDINGOtherMHN TRICARENORTH
CT060669107OtherUBH/UNITED HEALTHCARE WELLMORE GRP/FACILITY
CT12659252OtherCAQH
CT4679887OtherCIGNA BEHAVIORAL HEALTH- WELLMORE
CT9951843OtherAETNA BEHAVIORAL HEALTH
CT004392020Medicaid
CTPENDINGOtherMHN MANAGED HEALTH NETWORK
CTD339123-141 E MAINOtherBEACON HEALTH STRATEGIES
CT060669107OtherUBH/CONNECTICARE WELLMORE GRP/FACILITY
CT060669107OtherOPTUM BEHAVIORAL HEALTH/UBH WELLMORE GRP/FACILITY
CTNOT ELIGIBLEMedicare PIN