Provider Demographics
NPI:1003065459
Name:SILVERBERG, SUE ELLEN (LCPC)
Entity Type:Individual
Prefix:MS
First Name:SUE
Middle Name:ELLEN
Last Name:SILVERBERG
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:230 S DAVIS ST
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59801-1309
Mailing Address - Country:US
Mailing Address - Phone:406-728-5866
Mailing Address - Fax:
Practice Address - Street 1:230 S DAVIS ST
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59801-1309
Practice Address - Country:US
Practice Address - Phone:406-728-5866
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-10
Last Update Date:2015-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT1358-LCPC101YM0800X
104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No104100000XBehavioral Health & Social Service ProvidersSocial Worker