Healthcare Provider Details

I. General information

NPI: 1487564639
Provider Name (Legal Business Name): MISS STACHAKAY RENEE SILVERA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/10/2026
Last Update Date: 09/10/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 SMITH ST
PROVIDENCE RI
02908-2729
US

IV. Provider business mailing address

67 CAMERON ST
PAWTUCKET RI
02861-1713
US

V. Phone/Fax

Practice location:
  • Phone: 401-808-6013
  • Fax: 401-270-5322
Mailing address:
  • Phone: 347-614-8893
  • Fax: 401-270-5322

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCSW04446
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: