=====================================================
General NPI Number Information
=====================================================
NPI Number | 1093364705
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DOMINIQUE SILVESTRI MSW
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/05/2019
-----------------------------------------------------
Last Update Date | 07/07/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 617 UNION AVE BUILDING 3 SUITE 11
-----------------------------------------------------
City | BRIELLE
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08730
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 732-606-4634
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6 KILMER RD UNIT A121
-----------------------------------------------------
City | EDISON
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08817-2432
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 732-606-4634
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 104100000X
-----------------------------------------------------
Taxonomy Name | Social Worker
-----------------------------------------------------
License Number | 44SL06452200
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------