Healthcare Provider Details

I. General information

NPI: 1194049205
Provider Name (Legal Business Name): THERESE MARIE DASILVA LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/18/2010
Last Update Date: 03/18/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1835 EL CAJON BLVD SUITE A
SAN DIEGO CA
92103-2591
US

IV. Provider business mailing address

1835 EL CAJON BLVD SUITE A
SAN DIEGO CA
92103-2591
US

V. Phone/Fax

Practice location:
  • Phone: 858-222-0020
  • Fax: 619-298-7416
Mailing address:
  • Phone: 858-222-0020
  • Fax: 619-298-7416

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCS19963
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: