Provider Demographics
NPI:1770303620
Name:SILVA OCAMPO, EVELYN ANTONELLA
Entity type:Individual
Prefix:
First Name:EVELYN
Middle Name:ANTONELLA
Last Name:SILVA OCAMPO
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 1:2611 NW 56TH AVE # ATP506
Mailing Address - Street 2:
Mailing Address - City:LAUDERHILL
Mailing Address - State:FL
Mailing Address - Zip Code:33313-2484
Mailing Address - Country:US
Mailing Address - Phone:470-981-3422
Mailing Address - Fax:
Practice Address - Street 1:2611 NW 56TH AVE # ATP506
Practice Address - Street 2:
Practice Address - City:LAUDERHILL
Practice Address - State:FL
Practice Address - Zip Code:33313-2484
Practice Address - Country:US
Practice Address - Phone:470-981-3422
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-15
Last Update Date:2024-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician