Provider Demographics
NPI:1801528740
Name:DASILVA, LAURA QUEIROZ (MA EDM CERTIFIED)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:QUEIROZ
Last Name:DASILVA
Suffix:
Gender:F
Credentials:MA EDM CERTIFIED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:850 N 22ND ST APT 3R
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19130-1457
Mailing Address - Country:US
Mailing Address - Phone:516-712-5714
Mailing Address - Fax:
Practice Address - Street 1:850 N 22ND ST APT 3R
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19130-1457
Practice Address - Country:US
Practice Address - Phone:516-712-5714
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-29
Last Update Date:2022-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1517937211103TS0200X
PA2758609103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool