Healthcare Provider Details

I. General information

NPI: 1336398817
Provider Name (Legal Business Name): NICOLE DASILVA LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/09/2008
Last Update Date: 09/18/2026
Certification Date: 09/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

795 MIDDLE ST
FALL RIVER MA
02721-1798
US

IV. Provider business mailing address

74 OHIO ST
NEW BEDFORD MA
02745-2726
US

V. Phone/Fax

Practice location:
  • Phone: 508-675-5600
  • Fax:
Mailing address:
  • Phone: 508-965-9129
  • Fax: 844-266-5677

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number215200
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: