Healthcare Provider Details

I. General information

NPI: 1942590294
Provider Name (Legal Business Name): MEGAN E SILVA LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/07/2011
Last Update Date: 04/07/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

605 11TH AVE E
GOODING ID
83330-5368
US

IV. Provider business mailing address

605 11TH AVE E
GOODING ID
83330-5368
US

V. Phone/Fax

Practice location:
  • Phone: 208-934-8461
  • Fax: 208-934-5437
Mailing address:
  • Phone: 208-934-8461
  • Fax: 208-934-5437

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberLMSW-30920
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: