Healthcare Provider Details
I. General information
NPI: 1366493462
Provider Name (Legal Business Name): TODD RUSSELL SILVERSTEIN PSY.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N
II. Dates (important events)
Enumeration Date: 05/13/2006
Last Update Date: 08/01/2024
Certification Date: 08/01/2024
Deactivation Date:
Reactivation Date:
III. Provider practice location address
11201 BENTON ST
LOMA LINDA CA
92357-4722
US
IV. Provider business mailing address
PO BOX 331
NORWAY MI
49870-0331
US
V. Phone/Fax
- Phone: 909-825-7084
- Fax:
- Phone: 906-309-2061
- Fax: 888-874-5476
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 103G00000X |
| Taxonomy | Clinical Neuropsychologist |
| License Number | 6301014521 |
| License Number State | MI |
| # 2 | |
| Primary Taxonomy | N |
| Taxonomy Code | 103T00000X |
| Taxonomy | Psychologist |
| License Number | 6301014521 |
| License Number State | MI |
| # 3 | |
| Primary Taxonomy | N |
| Taxonomy Code | 103TA0400X |
| Taxonomy | Addiction (Substance Use Disorder) Psychologist |
| License Number | 6301014521 |
| License Number State | MI |
| # 4 | |
| Primary Taxonomy | N |
| Taxonomy Code | 103TA0700X |
| Taxonomy | Adult Development & Aging Psychologist |
| License Number | 6301014521 |
| License Number State | MI |
| # 5 | |
| Primary Taxonomy | N |
| Taxonomy Code | 103TB0200X |
| Taxonomy | Cognitive & Behavioral Psychologist |
| License Number | 6301014521 |
| License Number State | MI |
| # 6 | |
| Primary Taxonomy | N |
| Taxonomy Code | 103TC0700X |
| Taxonomy | Clinical Psychologist |
| License Number | 6301014521 |
| License Number State | MI |
| # 7 | |
| Primary Taxonomy | N |
| Taxonomy Code | 103TC2200X |
| Taxonomy | Clinical Child & Adolescent Psychologist |
| License Number | 6301014521 |
| License Number State | MI |
| # 8 | |
| Primary Taxonomy | N |
| Taxonomy Code | 103TF0000X |
| Taxonomy | Family Psychologist |
| License Number | 6301014521 |
| License Number State | MI |
| # 9 | |
| Primary Taxonomy | N |
| Taxonomy Code | 103TF0200X |
| Taxonomy | Forensic Psychologist |
| License Number | 6301014521 |
| License Number State | MI |
| # 10 | |
| Primary Taxonomy | N |
| Taxonomy Code | 103TM1800X |
| Taxonomy | Intellectual & Developmental Disabilities Psychologist |
| License Number | 6301014521 |
| License Number State | MI |
| # 11 | |
| Primary Taxonomy | N |
| Taxonomy Code | 103TP2701X |
| Taxonomy | Group Psychotherapy Psychologist |
| License Number | 6301014521 |
| License Number State | MI |
| # 12 | |
| Primary Taxonomy | N |
| Taxonomy Code | 103TH0004X |
| Taxonomy | Health Psychologist |
| License Number | 6301014521 |
| License Number State | MI |
VIII. Authorized Official
Name:
Title or Position:
Credential:
Phone:
