Healthcare Provider Details

I. General information

NPI: 1114430378
Provider Name (Legal Business Name): BALDEMAR SILVA LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/09/2017
Last Update Date: 11/17/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 MERCER AVE
DECATUR IN
46733-2303
US

IV. Provider business mailing address

1100 MERCER AVE
DECATUR IN
46733-2303
US

V. Phone/Fax

Practice location:
  • Phone: 260-724-2145
  • Fax: 260-728-3852
Mailing address:
  • Phone: 260-724-2145
  • Fax: 260-728-3852

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number34007650A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: