Provider Demographics
NPI:1053300897
Name:SILVER, GERALD M (PHD)
Entity Type:Individual
Prefix:DR
First Name:GERALD
Middle Name:M
Last Name:SILVER
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:152 RANCHO BONITA WAY
Mailing Address - Street 2:
Mailing Address - City:SONOMA
Mailing Address - State:CA
Mailing Address - Zip Code:95476-3023
Mailing Address - Country:US
Mailing Address - Phone:707-996-9638
Mailing Address - Fax:707-939-9563
Practice Address - Street 1:454 W NAPA ST
Practice Address - Street 2:
Practice Address - City:SONOMA
Practice Address - State:CA
Practice Address - Zip Code:95476-6519
Practice Address - Country:US
Practice Address - Phone:707-938-0226
Practice Address - Fax:707-939-9563
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-14
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY5662103T00000X, 103TC0700X, 103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103T00000XBehavioral Health & Social Service ProvidersPsychologist
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Not Answered103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00PL5662Medicare PIN