Healthcare Provider Details

I. General information

NPI: 1851587992
Provider Name (Legal Business Name): CHARLES I. SILVERSTEIN PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/22/2007
Last Update Date: 09/22/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1088 CAMBRIDGE ST
NOVATO CA
94947-4963
US

IV. Provider business mailing address

PO BOX 804
NOVATO CA
94948-0804
US

V. Phone/Fax

Practice location:
  • Phone: 415-884-0229
  • Fax:
Mailing address:
  • Phone: 415-884-0229
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPSY 6777
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number994
License Number StateHI
# 3
Primary TaxonomyN
Taxonomy Code103TF0200X
TaxonomyForensic Psychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: