Healthcare Provider Details

I. General information

NPI: 1124528609
Provider Name (Legal Business Name): MIRA SILBERG, LCSWC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/20/2018
Last Update Date: 02/20/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

121 CONGRESSIONAL LN STE 604
ROCKVILLE MD
20852-1562
US

IV. Provider business mailing address

PO BOX 34804
BETHESDA MD
20827-0804
US

V. Phone/Fax

Practice location:
  • Phone: 301-275-1376
  • Fax:
Mailing address:
  • Phone: 301-275-1376
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. MIRA SILBERG
Title or Position: OWNER
Credential: LCSWC
Phone: 301-275-1376