Provider Demographics
NPI:1992017495
Name:SILVA, MARY PAUL SR
Entity type:Individual
Prefix:MS
First Name:MARY
Middle Name:PAUL
Last Name:SILVA
Suffix:SR
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:505 S ACACIA AVE
Mailing Address - Street 2:
Mailing Address - City:RIPON
Mailing Address - State:CA
Mailing Address - Zip Code:95366-2629
Mailing Address - Country:US
Mailing Address - Phone:209-277-5325
Mailing Address - Fax:
Practice Address - Street 1:800 SCENIC DR
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95350-6131
Practice Address - Country:US
Practice Address - Phone:209-277-5325
Practice Address - Fax:209-525-6253
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-13
Last Update Date:2010-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health