=====================================================
General NPI Number Information
=====================================================
NPI Number | 1720459290
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SHERYL SILVER
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/09/2015
-----------------------------------------------------
Last Update Date | 10/09/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 248 W 108TH ST
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10025-2956
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 646-739-8117
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 565 FORT WASHINGTON AVE 3B
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10033-1935
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 917-344-9312
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | 073545
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------