Provider Demographics
NPI:1588940670
Name:SILVA, MYLENE MAYUMI (LMHC, NCC, CBHCMS)
Entity type:Individual
Prefix:
First Name:MYLENE
Middle Name:MAYUMI
Last Name:SILVA
Suffix:
Gender:F
Credentials:LMHC, NCC, CBHCMS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:615 105TH LN N
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33716-3805
Mailing Address - Country:US
Mailing Address - Phone:502-724-0858
Mailing Address - Fax:
Practice Address - Street 1:615 105TH LN N
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33716-3805
Practice Address - Country:US
Practice Address - Phone:502-724-0858
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-02
Last Update Date:2018-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL292200101YM0800X
FLCBHCMS100485171M00000X
FLMH 12438101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL012215100Medicaid