1578578142 NPI number — ELLEN D WEINICK SILBERT LICSW

Table of content: ELLEN D WEINICK SILBERT LICSW (NPI 1578578142)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1578578142 NPI number — ELLEN D WEINICK SILBERT LICSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WEINICK SILBERT
Provider First Name:
ELLEN
Provider Middle Name:
D
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LICSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1578578142
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/12/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
275 SEAWARD BND
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TEATICKET
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02536-5843
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
860-575-4062
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
275 SEAWARD BND
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TEATICKET
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02536-5843
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
860-575-4062
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/30/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  117806 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1041C0700X , with the licence number: 001043 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 336214 . This is a "MHN" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 140001043CT03 . This is a "ANTHEM BLUE CROSS" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".




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