=====================================================
General NPI Number Information
=====================================================
NPI Number | 1871030015
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | TIMOTHY SILVESTRI COUNSELING SERVICES
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/26/2017
-----------------------------------------------------
Last Update Date | 05/09/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 623 W UNION BLVD SUITE 1C
-----------------------------------------------------
City | BETHLEHEM
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 18018-3708
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 610-751-2024
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 701 W. UNION BLVD. SUITE 2
-----------------------------------------------------
City | BETHLEHEM
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 18018-3708
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 610-751-2024
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PSYCHOLOGIST/OWNER
-----------------------------------------------------
Name | DR. TIMOTHY J SILVESTRI
-----------------------------------------------------
Credential | PH.D.
-----------------------------------------------------
Telephone | 610-751-2024
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103T00000X
-----------------------------------------------------
Taxonomy Name | Psychologist
-----------------------------------------------------
License Number | PS015571
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------