Provider Demographics
NPI:1861209264
Name:JARA-SILVA, JONNY'S
Entity type:Individual
Prefix:
First Name:JONNY'S
Middle Name:
Last Name:JARA-SILVA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23 PONDVIEW TER
Mailing Address - Street 2:
Mailing Address - City:EAST HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06512-5400
Mailing Address - Country:US
Mailing Address - Phone:203-507-8895
Mailing Address - Fax:
Practice Address - Street 1:23 PONDVIEW TER
Practice Address - Street 2:
Practice Address - City:EAST HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06512-5400
Practice Address - Country:US
Practice Address - Phone:203-507-8895
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-18
Last Update Date:2024-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician