1851363774 NPI number — EDWARD GENE SILVERHARDT LCSW, BCD

Table of content: EDWARD GENE SILVERHARDT LCSW, BCD (NPI 1851363774)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1851363774 NPI number — EDWARD GENE SILVERHARDT LCSW, BCD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SILVERHARDT
Provider First Name:
EDWARD
Provider Middle Name:
GENE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LCSW, BCD
Provider Gender Code:
M

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:
1851363774
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/08/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 12965
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
RENO
Provider Business Mailing Address State Name:
NV
Provider Business Mailing Address Postal Code:
89510-2965
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
775-250-4359
Provider Business Mailing Address Fax Number:
775-322-9713

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2470 WRONDEL WAY
Provider Second Line Business Practice Location Address:
SUITE 111
Provider Business Practice Location Address City Name:
RENO
Provider Business Practice Location Address State Name:
NV
Provider Business Practice Location Address Postal Code:
89502-3701
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
775-250-4359
Provider Business Practice Location Address Fax Number:
775-322-9713
Provider Enumeration Date:
02/03/2006

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:  4756-C , registered in the state of NV ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: P00114504 . This is a "RAILROAD" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".




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