MEDICARE: DR. NANCY WILSON SILVA PHD, LMHC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101Y00000X	Counselor	0003049	FL
2	101YA0400X	Addiction (Substance Use Disorder) Counselor	37854
3	101YP2500X	Professional Counselor	0003049	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	37854	OTHER		NCC
2	37854	OTHER		MAC
3	0003049	OTHER	FL	LMHC

General Provider Information

NPI Number	:	1679753776
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NANCY WILSON SILVA PHD, LMHC

Provider Business Mailing Address
First Line	:	1224 JACKSON ST N
Second Line	:
City	:	ST PETERSBURG
State	:	FL
Zip	:	33705-1037
Country	:	US
Telephone Number	:	727-422-4817
Fax Number	:

Provider Business Practice Location Address
First Line	:	1224 JACKSON ST N
Second Line	:
City	:	ST PETERSBURG
State	:	FL
Zip	:	33705-1037
Country	:	US
Telephone Number	:	727-422-4817
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/07/2007
Last Update Date	:	11/07/2007

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