MEDICARE: CHRISTIANE DASILVA MS, LPC, NCC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	PC017695	PA

General Provider Information

NPI Number	:	1679394142
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISTIANE DASILVA MS, LPC, NCC

Provider Business Mailing Address
First Line	:	323 STOWE RD
Second Line	:
City	:	TANNERSVILLE
State	:	PA
Zip	:	18372-7886
Country	:	US
Telephone Number	:	570-350-2505
Fax Number	:

Provider Business Practice Location Address
First Line	:	105 TERRACE DR STE 102
Second Line	:
City	:	STROUDSBURG
State	:	PA
Zip	:	18360-7510
Country	:	US
Telephone Number	:	570-620-4311
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/17/2024
Last Update Date	:	10/17/2024

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