MEDICARE: MS. BEVERLY CAROL SILK MFT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist	MFC19764	CA

General Provider Information

NPI Number	:	1942210794
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. BEVERLY CAROL SILK MFT

Provider Business Mailing Address
First Line	:	301 S FAIR OAKS AVE
Second Line	:	SUITE 406B
City	:	PASADENA
State	:	CA
Zip	:	91105-2561
Country	:	US
Telephone Number	:	626-793-4487
Fax Number	:	626-793-4487

Provider Business Practice Location Address
First Line	:	301 S FAIR OAKS AVE
Second Line	:	SUITE 406B
City	:	PASADENA
State	:	CA
Zip	:	91105-2561
Country	:	US
Telephone Number	:	626-793-4487
Fax Number	:	626-793-4487

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/08/2006
Last Update Date	:	07/08/2007

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