1770659302 NPI number — MRS. MARY AGNES SILBERSTEIN MSW LCSW C

Table of content: MRS. MARY AGNES SILBERSTEIN MSW LCSW C (NPI 1770659302)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1770659302 NPI number — MRS. MARY AGNES SILBERSTEIN MSW LCSW C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SILBERSTEIN
Provider First Name:
MARY
Provider Middle Name:
AGNES
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MSW LCSW C
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:
1770659302
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8811 COLESVILLE ROAD
Provider Second Line Business Mailing Address:
SUITE 104
Provider Business Mailing Address City Name:
SILVER SPRING
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
20910-4327
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
301-587-2424
Provider Business Mailing Address Fax Number:
301-585-7392

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8811 COLESVILLE ROAD
Provider Second Line Business Practice Location Address:
SUITE 104
Provider Business Practice Location Address City Name:
SILVER SPRING
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
20910-4327
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
301-587-2424
Provider Business Practice Location Address Fax Number:
301-585-7392
Provider Enumeration Date:
11/27/2006

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: 103T00000X , with the licence number:  03498 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 103T00000X , with the licence number: LC301470 , registered in the state of DC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: PV104268 . This is a "APS" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 0005625591 . This is a "AETNA" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".




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