Healthcare Provider Details

I. General information

NPI: 1922413152
Provider Name (Legal Business Name): AMY LIPPINCOTT SILVA M.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/26/2014
Last Update Date: 06/26/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

417 REIGERTS LN
ANNVILLE PA
17003-2120
US

IV. Provider business mailing address

417 REIGERTS LN
ANNVILLE PA
17003-2120
US

V. Phone/Fax

Practice location:
  • Phone: 717-867-8335
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberBH001022
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code103TF0000X
TaxonomyFamily Psychologist
License NumberBH001022
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code103TP2701X
TaxonomyGroup Psychotherapy Psychologist
License NumberBH001022
License Number StatePA
# 4
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License NumberBH001022
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: