Healthcare Provider Details

I. General information

NPI: 1831119551
Provider Name (Legal Business Name): ROBERT B SILVER PH.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/19/2006
Last Update Date: 02/06/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4461 CAMINO REAL WAY
FORT MYERS FL
33966-1019
US

IV. Provider business mailing address

4461 CAMINO REAL WAY
FORT MYERS FL
33912-1019
US

V. Phone/Fax

Practice location:
  • Phone: 239-936-1336
  • Fax: 239-936-4927
Mailing address:
  • Phone: 239-936-1336
  • Fax: 239-936-4927

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License NumberPY2600
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPY2600
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License NumberPY2600
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code103TF0200X
TaxonomyForensic Psychologist
License NumberPY2600
License Number StateFL
# 5
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMF519
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: