Healthcare Provider Details

I. General information

NPI: 1568821445
Provider Name (Legal Business Name): JURACI MARIA DA SILVA M.A., PH.D
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/19/2016
Last Update Date: 02/19/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

68 LAIGHT ST APT 7
NEW YORK NY
10013-2034
US

IV. Provider business mailing address

68 LAIGHT ST APT 7
NEW YORK NY
10013-2034
US

V. Phone/Fax

Practice location:
  • Phone: 516-987-4200
  • Fax: 800-297-0976
Mailing address:
  • Phone: 516-987-4200
  • Fax: 800-297-0976

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number018633-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: