Basic Information
| Provider Information | |||||||||
| NPI: | 1043532633 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SILVA | ||||||||
| FirstName: | PATRICIA | ||||||||
| MiddleName: | YERENA | ||||||||
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| Credential: | LBSW,MSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3421 MISTY MEADOWS DR NE | ||||||||
| Address2: | |||||||||
| City: | RIO RANCHO | ||||||||
| State: | NM | ||||||||
| PostalCode: | 871440551 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5059078053 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 4312 CARLISLE BLVD NE | ||||||||
| Address2: | |||||||||
| City: | ALBUQUERQUE | ||||||||
| State: | NM | ||||||||
| PostalCode: | 871074811 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5053233785 | ||||||||
| FaxNumber: | 5053233850 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/23/2010 | ||||||||
| LastUpdateDate: | 11/11/2010 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | 52886 | TX | N | Behavioral Health & Social Service Providers | Counselor | Mental Health | 104100000X | B-07357 | NM | Y | Behavioral Health & Social Service Providers | Social Worker |
No ID Information.