Healthcare Provider Details

I. General information

NPI: 1215784160
Provider Name (Legal Business Name): MATILDE A SILVESTRE CONSTANZO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/30/2024
Last Update Date: 04/30/2024
Certification Date: 04/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1952 E ALLEGHENY AVE
PHILADELPHIA PA
19134-3122
US

IV. Provider business mailing address

3255 KENSINGTON AVE
PHILADELPHIA PA
19134-1935
US

V. Phone/Fax

Practice location:
  • Phone: 215-291-8151
  • Fax: 215-291-4428
Mailing address:
  • Phone: 215-423-5000
  • Fax: 215-423-9600

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: