Provider Demographics
NPI:1073225835
Name:SILK, JUSTIN MATTHEW (LMHC)
Entity Type:Individual
Prefix:MR
First Name:JUSTIN
Middle Name:MATTHEW
Last Name:SILK
Suffix:
Gender:M
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 SHERMAN AVE APT 6J
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10034-5635
Mailing Address - Country:US
Mailing Address - Phone:216-210-4636
Mailing Address - Fax:
Practice Address - Street 1:101 SHERMAN AVE APT 6J
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10034-5635
Practice Address - Country:US
Practice Address - Phone:216-210-4636
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-22
Last Update Date:2022-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012064101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health