Provider Demographics
NPI:1699345280
Name:SILVA, DAVID VERNON (LCSW)
Entity type:Individual
Prefix:
First Name:DAVID VERNON
Middle Name:
Last Name:SILVA
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:VERNON
Other - Middle Name:
Other - Last Name:SILVA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:PO BOX 6518
Mailing Address - Street 2:
Mailing Address - City:SAN PEDRO
Mailing Address - State:CA
Mailing Address - Zip Code:90734-6518
Mailing Address - Country:US
Mailing Address - Phone:415-320-4517
Mailing Address - Fax:
Practice Address - Street 1:3645 S EMILY ST
Practice Address - Street 2:
Practice Address - City:SAN PEDRO
Practice Address - State:CA
Practice Address - Zip Code:90731-6447
Practice Address - Country:US
Practice Address - Phone:415-320-4517
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-28
Last Update Date:2021-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA25153101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health