Provider Demographics
NPI:1649880444
Name:SILVA, FABIANA ARETUSA (LMSW)
Entity type:Individual
Prefix:
First Name:FABIANA
Middle Name:ARETUSA
Last Name:SILVA
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:92 CONNECTICUT BOULEVARD
Mailing Address - Street 2:
Mailing Address - City:EAST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06118
Mailing Address - Country:US
Mailing Address - Phone:860-528-1359
Mailing Address - Fax:860-290-4142
Practice Address - Street 1:809 MAIN ST
Practice Address - Street 2:
Practice Address - City:EAST HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06108-3117
Practice Address - Country:US
Practice Address - Phone:860-528-1359
Practice Address - Fax:860-290-4142
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-06
Last Update Date:2020-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT44871041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical