Provider Demographics
NPI:1164823910
Name:SILVERMAN, MARCUS MICHAEL (MA, LP)
Entity Type:Individual
Prefix:MR
First Name:MARCUS
Middle Name:MICHAEL
Last Name:SILVERMAN
Suffix:
Gender:M
Credentials:MA, LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1212 OCEAN AVE
Mailing Address - Street 2:1D
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11230-7473
Mailing Address - Country:US
Mailing Address - Phone:347-807-5870
Mailing Address - Fax:
Practice Address - Street 1:1115 BROADWAY FL 10
Practice Address - Street 2:#1003
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10010-3454
Practice Address - Country:US
Practice Address - Phone:347-807-5870
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-11
Last Update Date:2016-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000967102L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes102L00000XBehavioral Health & Social Service ProvidersPsychoanalyst