Provider Demographics
NPI:1306876222
Name:SILVA, SARA P (LICSW)
Entity type:Individual
Prefix:MS
First Name:SARA
Middle Name:P
Last Name:SILVA
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:MS
Other - First Name:SARA
Other - Middle Name:E
Other - Last Name:PONTIOUS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LICSW
Mailing Address - Street 1:11 BEARSE AVE
Mailing Address - Street 2:#3
Mailing Address - City:DORCHESTER CENTER
Mailing Address - State:MA
Mailing Address - Zip Code:02124-5802
Mailing Address - Country:US
Mailing Address - Phone:617-259-8004
Mailing Address - Fax:617-698-1274
Practice Address - Street 1:464 GRANITE AVE
Practice Address - Street 2:SUITE 25
Practice Address - City:MILTON
Practice Address - State:MA
Practice Address - Zip Code:02186-5625
Practice Address - Country:US
Practice Address - Phone:617-259-8004
Practice Address - Fax:617-698-1274
Is Sole Proprietor?:No
Enumeration Date:2006-07-04
Last Update Date:2010-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10274101041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical