Healthcare Provider Details

I. General information

NPI: 1659594778
Provider Name (Legal Business Name): FARRELL R. SILVERBERG PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/10/2007
Last Update Date: 11/01/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2024 LOCUST ST
PHILADELPHIA PA
19103-5614
US

IV. Provider business mailing address

2024 LOCUST ST
PHILADELPHIA PA
19103-5614
US

V. Phone/Fax

Practice location:
  • Phone: 215-545-1096
  • Fax:
Mailing address:
  • Phone: 215-545-1096
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code102L00000X
TaxonomyPsychoanalyst
License Number000800
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code103TP0814X
TaxonomyPsychoanalysis Psychologist
License Number01025
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code103TP0814X
TaxonomyPsychoanalysis Psychologist
License Number4478L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: