Healthcare Provider Details

I. General information

NPI: 1801984729
Provider Name (Legal Business Name): ELLIOT M. SILVERSTEIN PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/10/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

DOROTHEA DIX HOSPITAL 3601 MSC CENTER
RALEIGH NC
27699-3601
US

IV. Provider business mailing address

204 MADERA LN
CHAPEL HILL NC
27517-8384
US

V. Phone/Fax

Practice location:
  • Phone: 919-733-5344
  • Fax: 919-733-9441
Mailing address:
  • Phone: 919-933-2112
  • Fax: 919-733-9441

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number736
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: