Healthcare Provider Details

I. General information

NPI: 1497798482
Provider Name (Legal Business Name): JOANN LEE SILVA MSW, LICSW, LCSW,
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/14/2006
Last Update Date: 05/09/2025
Certification Date: 07/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2725 AGUA FRIA STREET APT A218
SANTA FE NM
87507
US

IV. Provider business mailing address

2725 AGUA FRIA STREET APT A218
SANTA FE NM
87507
US

V. Phone/Fax

Practice location:
  • Phone: 650-761-4392
  • Fax: 650-761-4399
Mailing address:
  • Phone: 650-761-4392
  • Fax: 650-761-4399

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number103396
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCS14522
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number3214
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: