Provider Demographics
NPI:1316414550
Name:SILVERA, JOSEPH ERIC (RBT)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:ERIC
Last Name:SILVERA
Suffix:
Gender:M
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3646 SE FRANCIS ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97202-3211
Mailing Address - Country:US
Mailing Address - Phone:602-460-8451
Mailing Address - Fax:
Practice Address - Street 1:3646 SE FRANCIS ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97202-3211
Practice Address - Country:US
Practice Address - Phone:602-460-8451
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-25
Last Update Date:2018-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRBT-18-58780106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician